According to: It can be said responsibly that there are many misunderstandings about the on-site first aid for drowning, including medical personnel, not to mention the mass media and ordinary people.
You may be a little dissatisfied with how a professional doctor trained in CPR can save a drowning person.
So, please listen to the question: Is the order of drowning rescue C-A-B or A-B-C?
Let’s look at some [scenes]
It is true to say that Chinese children are unlucky. There is no one to take care of them during the summer vacation and there is no professional rescue for drowning. The following content comes from the emergency department doctor @ Emergency Nighthawk of Guangzhou First People’s Hospital. Let’s see how professional emergency department doctors guide the drowning rescue site.
Drowning concept
The process of primary respiratory injury caused by inundation.
The drowning process can be roughly divided into
1. Breath-holding period
2. Laryngeal spasm
3. Water entering respiratory tract
4. Cardiac arrest
Cardiac arrest can also occur during laryngeal spasm or water entering respiratory tract.
Drowning rescue
First of all, ensure the safety of rescuers themselves and try to use ropes and life-saving facilities for shore rescue. Group rescue is better than individual combat. Being able to swim does not mean being able to rescue in water, which requires special training.
The State and First Aid Measures of Drowned Persons after Rescuing Shore;
1. Wake, breathing and pulse: Call 120, accompany, keep warm, wait for rescue personnel or send to hospital for observation.
2. Coma (no response to the call), breathing and pulse: Call 120, clean up foreign bodies in nose and mouth, stabilize the lateral position, and wait for rescue personnel. Closely observe the respiratory pulse and cardiopulmonary resuscitation if necessary.
3. Coma, no breathing and pulse: Similar to the state of “fake death”, the patient has laryngeal spasm, no breathing and weak pulse, which is on the verge of stopping. At this time, only open airway and artificial respiration are given, and the pulse and heartbeat can be rapidly enhanced. After resuming breathing, you can lie on your side and wait for rescue personnel.
4. Coma, no breathing and no pulse: Immediately clean up foreign bodies in nose and mouth, open airway, artificial respiration and chest compression, i.e. Adopt the traditional A-B-C cardiopulmonary resuscitation first aid sequence. Remember to call 120 at the same time and continue resuscitation until the patient’s respiratory pulse recovers or the first aid personnel arrive.
Cardiac arrest in drowning person, C-A-B or A-B-C?
The most important update of the 2010 guidelines for cardiopulmonary resuscitation is to change the first aid sequence of resuscitation from A-B-C to C-A-B, and even advocate simple chest compressions. Why is A-B-C recommended for drowning cardiac arrest?
The root cause is that drowning is asphyxia, hypoxic cardiac arrest, Oxygen supply is the primary goal, so A-B-C sequence is adopted for first aid. However, most of the out-of-hospital cardiac arrest population is cardiogenic cardiac arrest, and the patient still has sufficient oxygenation in the body before cardiac arrest, and some even have dying wheezing, which can provide partial ventilation and oxygenation. At this time, maintaining basic circulation to supply cerebral blood supply is the primary goal, so C-A-B first aid sequence is adopted.
The idea of simple chest compressions is based on the above pathophysiological process of cardiac arrest, so simple chest compressions are not applicable to drowning cardiac arrest. These are specifically discussed in the 2010 Guidelines for Cardiopulmonary Resuscitation.
Artificial respiration is crucial to the recovery of drowned people.
Since the underlying mechanism of drowning is lack of oxygen, The latest evidence-based medical recommendation on drowning is to take five times of artificial respiration first, A further 30 chest compressions were performed, followed by 2 artificial respirations, followed by 30 chest compressions, followed by a 2: 30 cycle. Not only was artificial respiration given first, but the first 2 artificial respirations were increased to 5 artificial respirations in order to provide adequate oxygenation to the patient at the first time. (New England Journal of Medicine N Engl J Med 2012; 366: 2102-2110)
Understanding of Water Control Law
The water control method has a long history, with many tricks, such as bumping on horseback, hanging upside down on trees, abdominal impact, and WeChat’s very wide process of [running upside down]……
It originated from people’s early exploration of drowning first aid. With the establishment of three major technologies of modern cardiopulmonary resuscitation: artificial respiration, chest compressions and electric defibrillation, Water control has long been abandoned. Now evidence-based medicine has made it clear that water control delays recovery, aggravates aspiration and significantly increases mortality. The guidelines clearly point out that there is no evidence that water can become a foreign body blocking the airway, and don’t waste time using abdominal or chest impact methods to control water.
We can also see from the damage process of drowning, For conscious drowning or unconscious but breathing pulse survivors, The drowning time is relatively short, the lung does not inhale water at all or only inhales little water, so it is completely unnecessary to control water. The process of controlling water leads to the discharge of gastric contents, which increases the risk of aspiration and is harmful and useless. For drowning cardiac arrest patients, water control causes delay of cardiopulmonary resuscitation, which also increases aspiration and increases mortality.
In fact, no matter what kind of water control method, the water control method basically controls the contents of the stomach and the water in the stomach, and the water in the lung is difficult to control. On the contrary, in the process of cardiopulmonary resuscitation, the water in the lung will be absorbed into the circulation, thus improving the oxygenation capacity of the lung.
In short, any form of water control law is old, useless and harmful. Let the water control law go to hell.