I was at a paddling club meeting recently where the a recent death of a paddler (on a whitewater river) was being discussed. One of the paddlers on the trip was at the meeting and told the story of rescue and the attempt to revive the boater with CPR. It was quite sobering to hear the story from someone who had been there. 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. Several people on the trip where this accident took place were trained and up to date on rescue skills and CPR, and did everything possible. I do not mean to second guess what they did. One of them, however, suggested doing the Heimlich first if we are ever in the same situation, as it has since been suggested to him from several different sources. I have had only a basic CPR course and I don't remember this being discussed (just clearing the airway by sweeping the mouth with your fingers). I'm sure there are people on this list with more advanced training. Is using the Heimlich before CPR something included in rescue/first aid training specific to watersports or wilderness first aid, etc? Is this something paddlers with CPR training should know? Frank *************************************************************************** PaddleWise Paddling Mailing List Submissions: paddlewise_at_lists.intelenet.net Subscriptions: paddlewise-request_at_lists.intelenet.net Website: http://www.paddlewise.net/ ***************************************************************************
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 *************************************************************************** PaddleWise Paddling Mailing List Submissions: paddlewise_at_lists.intelenet.net Subscriptions: paddlewise-request_at_lists.intelenet.net Website: http://www.paddlewise.net/ ***************************************************************************
I've been a paramedic and Dive Rescue Specialist for approximately 17 yrs at the Albany Fire Dept. which is approx. 60 miles inland from the Oregon coast. During that time we've had four different physician advisors who have presented monthly training which included drowning. At no time did they recommend using the Heimlich maneuver. While I'm not well read on the subject, my reading has without exception concurred. Having said that, I think there is a situation in resuscitation which lends itself well to a veriation of the Heimlich maneuver. I have used it several times with great results. The normal reason the Heimlich maneuver is used is for airway obstruction. Secondarily, it may be used to remove water from the lungs which is currently out of favor. I've used it to remove air from the stomach. During CPR the stomach often gets pressurized which forces out the gastric contents in the supine patient - very bad news. Oftentimes continual suctioning is required and an NG tube or a specialized airway tube which blocks the esophagus is use. It occurred to me that if the patient was quickly placed in a sitting position and Heimliched from behind, the stomach may be depressurized and the continual stream of vomitting stopped. The gastric contents would remain low in the stomach while the air would be at the outlet to the esophagus. This proved effective for me and requires no specialized equipment. This is not a medically sanctioned technique, and I've not heard of it used for this situation. But, finding oneself in this situation may call for this. Air may be blocked from the stomach during ventilations by using the Sellick maneuver. This is done by applying pressure over the adams apple which collapses the esophagus but not the more rigid trachea. This may be used to keep gastric contents in the stomach and is widely accepted and taught. But, it may be difficult to use for long periods of time after the stomach has been hyperinflated. Good Paddling, BillAt 11:36 AM 6/12/99 -0700, Frank Lucian wrote: >I was at a paddling club meeting recently where the a recent death of a >paddler (on a whitewater river) was being discussed. One of the paddlers >on the trip was at the meeting and told the story of rescue and the >attempt to revive the boater with CPR. >It was quite sobering to hear the story from someone who had been there. > >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. > >Several people on the trip where this accident took place were trained >and up to date on rescue skills and CPR, and did everything possible. I >do not mean to second guess what they did. One of them, however, >suggested doing the Heimlich first if we are ever in the same situation, >as it has since been suggested to him from several different sources. > >I have had only a basic CPR course and I don't remember this being >discussed (just clearing the airway by sweeping the mouth with your >fingers). I'm sure there are people on this list with more advanced >training. Is using the Heimlich before CPR something included in >rescue/first aid training specific to watersports or wilderness first >aid, etc? Is this something paddlers with CPR training should know? > >Frank > >*************************************************************************** >PaddleWise Paddling Mailing List >Submissions: paddlewise_at_lists.intelenet.net >Subscriptions: paddlewise-request_at_lists.intelenet.net >Website: http://www.paddlewise.net/ >*************************************************************************** > > *************************************************************************** PaddleWise Paddling Mailing List Submissions: paddlewise_at_lists.intelenet.net Subscriptions: paddlewise-request_at_lists.intelenet.net Website: http://www.paddlewise.net/ ***************************************************************************
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