Mouth to mouth without barrier? - page 5

by Southern Magnolia 11,054 Views | 48 Comments

I will be beginning a BSN program in the fall. In preparation for school I was required to take CPR training. During the course of training the instructor mentioned the new compression first cpr (ccr) and stressed that no one... Read More


  1. 2
    Quote from 2011nursingstudent
    sorry, but you are misinformed. there is no law that requires healthcare providers, off the clock, without ppe to perform mouth to mouth, which would endanger the responder. the responder's safety is first, victim second.

    (in addition, there are only four states with "duty to rescue" laws for nurses and they are vermont, wisconsin, rhode island and minnesota. i have no idea what the details of those states' laws are, as i don't reside in any of them. i am assuming it is also responder's safety first in those states.)
    no, i am not misinformed, because you did not read my post.

    my post said if <~~~~ that is a very important word. if you choose to get involved, the law requires you to perform to the highest level of your training. you cannot pick and choose which parts of the training that you are going to utilize when performing cpr if you are a licensed professional.

    you cannot use "endanger the responder" as an excuse because the victim "might" have something that is not proven. that refers to not having to pull someone out of a burning car if you cannot do so safely, jumping over live electrical wires...things like that.

    i never stated that you were required to rescue someone...i just stated that from a moral aspect, i don't see how someone can sit there and watch someone die in a public place, have the ability to possibly save them, but wouldn't touch them on the 1% chance that they "might" have something.

    the purpose of ppe is for daily use, but i can assure you, even in a hospital setting, that will get thrown by the wayside in a heartbeat if someone is literally sitting there in a full-blown code because seconds count.
    suanna and lillymom like this.
  2. 0
    Quote from babylady
    no, i am not misinformed, because you did not read my post.

    my post said if <~~~~ that is a very important word. if you choose to get involved, the law requires you to perform to the highest level of your training. you cannot pick and choose which parts of the training that you are going to utilize when performing cpr if you are a licensed professional.

    you cannot use "endanger the responder" as an excuse because the victim "might" have something that is not proven. that refers to not having to pull someone out of a burning car if you cannot do so safely, jumping over live electrical wires...things like that.

    i never stated that you were required to rescue someone...i just stated that from a moral aspect, i don't see how someone can sit there and watch someone die in a public place, have the ability to possibly save them, but wouldn't touch them on the 1% chance that they "might" have something.

    the purpose of ppe is for daily use, but i can assure you, even in a hospital setting, that will get thrown by the wayside in a heartbeat if someone is literally sitting there in a full-blown code because seconds count.
    i'm not trying to be argumentative but this is not what is being taught. i just took an aha healthcare provider course one week ago and was told you can choose to perform cpr and still choose if you are going to do rescue breaths. i was told that this is the point behind changing the recommendation to 100 compressions before anything else. you can then choose - after the 100 compressions - to continue with compression only until help arrives or to go into the traditional pattern of breaths and compressions. this is for the adult. the recommendation remains the same for infant / child but we were again told it is a choice to do mouth to mouth - above and beyond the choice of getting involved and providing compressions.

    i'm not saying this is right or wrong. i would give rescue breaths even if i didn't have a barrier (as far as one can choose when not in the heat of the moment.)
  3. 1
    Quote from babylady
    my post said if <~~~~ that is a very important word. if you choose to get involved, the law requires you to perform to the highest level of your training. you cannot pick and choose which parts of the training that you are going to utilize when performing cpr if you are a licensed professional.

    you cannot use "endanger the responder" as an excuse because the victim "might" have something that is not proven. that refers to not having to pull someone out of a burning car if you cannot do so safely, jumping over live electrical wires...things like that.
    the endangerment standard does apply. that is why ppe(gloves, or in this case an oral barrier) is referred to as the "universal precaution". you protect/shield in accordance with anticipated risk in mind. certainly, we are free to disagree, but before anyone takes that as a mandate, please check with the state bon and a couple of good local malpractice attorneys. no soc may be used to mandate intervention that endangers the patient or the caregiver. i.e., i may be wilderness rescue trained world health organization rn, that does not mean that in that absence of a defib/aed i shall use a pair of jumper cables and a willys jeep. if you do not have the necessary tools to perform to the highest level of training, you are responsible to provide reasonable care within the defined limitations. we may not be required to expose ourselves to any environmental hazard to which a reasonable, trained, person would not.

    now, that is getting into the presence or absence of ppe. having btdt, if "the downer" appears to have a so in attendance, i will ask/direct them in assisting with care. direct pressure, mouth to mouth, etc.. as far as discounting essential ppe "in an emergency", i would submit that is a lack of training and/or experience in conjunction with adrenalization. seconds count. so do the next 20, 30, 40 years, anti-viral agents, chemo, time spent on the transplant list...

    performance bias: "i did it yesterday, and it didn't kill me; i'll be fine..." it is a maladaptive learning process by which we justify self-gratifying behaviors. it cannot be the basis for an ethical or legal framework (in fact, it isn't).

    bottom line- if you want to give the kiss of life without regrets, carry a barrier. if the barrier is more crap to carry, and you realize that it is unlikely to be replaced annually, and will likely, therefore, not be patent after prolonged exposure to heat/cold/uv rays and pocket lint, be prepared to take charge, and direct distressed sos in the best way to assist.
    SkiMama likes this.
  4. 0
    I may have come across as condescending or patronizing- that's not at all my intent. I've had quite a bit of direct care in pre-hospital and ED settings, and performed lab draws and venous access everyehere from NICU to Chemo. Before I became a desk jockey, I maintained a very high technical expertise.

    Because of that expertise, I frequently did things outside of the norm (that performance bias thing ), but I was always able to verbalize why my actions were "appropriate"- sticking w/o gloves, on some occasions, for one. Why did I do____? My first response was always that my actions were necessary for the patient's care and well-being, and I was fully validated. However, more directly, I performed the action(s) because in that particular arena, I pooped gold bricks, walked on water and snapped my fingers for an eagle to bring me M&Ms- it was gratifying to do what others could or would not do.

    When we have a strong emotional response to something, it is important to be very clear on the foundation for that response, and the liability (personal, ethical, or legal) that using that foundation for decision making may carry.

    Hence my interest in learning models, and successful high performance.
    Some great reading:

    The Survivors Club, by Ben Sherwood.
    http://www.amazon.com/Survivors-Club.../dp/0446580244

    Deep Survival, By Laurence Gonzales.
    http://www.amazon.com/Deep-Survival-...5305612&sr=1-1

    The Unthinkable, by Amanda Ripley.
    http://www.amazon.com/Unthinkable-Su...d_bxgy_b_img_c

    On the surface, these are inspiring, (generally- I didn't care so much for Gonzales) well written books, that offer some general conclusions about surviving traumatic events. On a deeper level, they begin to address how we prepare for crisis of any sort.

    To summarize: Survivors have a plan. They gather all available information about their new environment and/or changes in the present. They mentally (or when possible, physically) practice implementing the plan. They determine what the trigger for implementing the plan will be(i.e., you hear code blue, you grab the gloves that you carry in your pocket, and the ambu bag that you checked at the start of shift). When called for, they implement the plan without hesitation.

    Personal motivations vary, but some people do not pre-plan/prepare, so that a hero-motivation may be satisfied; others because they feel preparation mystically causes the event; some are just lazy. When we begin to assess our own motives, we frequently find that we are able to provide better care, with less trauma/risk by eliminating the personal investment in performing what can be a highly effiecient model, when we prepare.

    Incidence of HepC: +/- 2.5%
    http://www.epidemic.org/theFacts/the...rldPrevalence/
    Incidence of HIV:
    http://www.cdc.gov/hiv/topics/survei.../incidence.htm
    The CDC is grossly coy about numbers, here, but with between 36K and 56K new diagnoses per year, since 82, numbers are at least comparable to HepC.

    TB, etc.,etc. If you just ate a nacho chip and cut your gums, bit your tongues, blah, blah, blah, you're looking more at the 10% range for contracting something transmissable, depending on the victim's SES.
    Last edit by Rob72 on May 13, '11
  5. 0
    Quote from Rob72
    I may have come across as condescending or patronizing- that's not at all my intent. I've had quite a bit of direct care in pre-hospital and ED settings, and performed lab draws and venous access everyehere from NICU to Chemo. Before I became a desk jockey, I maintained a very high technical expertise.

    Because of that expertise, I frequently did things outside of the norm (that performance bias thing ), but I was always able to verbalize why my actions were "appropriate"- sticking w/o gloves, on some occasions, for one. Why did I do____? My first response was always that my actions were necessary for the patient's care and well-being, and I was fully validated. However, more directly, I performed the action(s) because in that particular arena, I pooped gold bricks, walked on water and snapped my fingers for an eagle to bring me M&Ms- it was gratifying to do what others could or would not do.

    When we have a strong emotional response to something, it is important to be very clear on the foundation for that response, and the liability (personal, ethical, or legal) that using that foundation for decision making may carry.

    Hence my interest in learning models, and successful high performance.
    Some great reading:

    The Survivors Club, by Ben Sherwood.
    http://www.amazon.com/Survivors-Club.../dp/0446580244

    Deep Survival, By Laurence Gonzales.
    http://www.amazon.com/Deep-Survival-...5305612&sr=1-1

    The Unthinkable, by Amanda Ripley.
    http://www.amazon.com/Unthinkable-Su...d_bxgy_b_img_c

    On the surface, these are inspiring, (generally- I didn't care so much for Gonzales) well written books, that offer some general conclusions about surviving traumatic events. On a deeper level, they begin to address how we prepare for crisis of any sort.

    To summarize: Survivors have a plan. They gather all available information about their new environment and/or changes in the present. They mentally (or when possible, physically) practice implementing the plan. They determine what the trigger for implementing the plan will be(i.e., you hear code blue, you grab the gloves that you carry in your pocket, and the ambu bag that you checked at the start of shift). When called for, they implement the plan without hesitation.

    Personal motivations vary, but some people do not pre-plan/prepare, so that a hero-motivation may be satisfied; others because they feel preparation mystically causes the event; some are just lazy. When we begin to assess our own motives, we frequently find that we are able to provide better care, with less trauma/risk by eliminating the personal investment in performing what can be a highly effiecient model, when we prepare.

    Incidence of HepC: +/- 2.5%
    http://www.epidemic.org/theFacts/the...rldPrevalence/
    Incidence of HIV:
    http://www.cdc.gov/hiv/topics/survei.../incidence.htm
    The CDC is grossly coy about numbers, here, but with between 36K and 56K new diagnoses per year, since 82, numbers are at least comparable to HepC.

    TB, etc.,etc. If you just ate a nacho chip and cut your gums, bit your tongues, blah, blah, blah, you're looking more at the 10% range for contracting something transmissable, depending on the victim's SES.
    I definately agree being prepared and protecting oneself is the ideal situation.
  6. 1
    Sorry, Rob and Nursing Student...you are both 190% incorrect in your reasoning.

    I just hope that neither one of you ever have to come across a bona-fide emergency where it is up to you to act and no one else, because trust me, your reasoning of why you can stand there and let someone die and pick and choose which parts of training you are going to use..is not going to be a valid defense in court.

    I guarantee it.
    suanna likes this.
  7. 0
    Quote from BabyLady
    Sorry, Rob and Nursing Student...you are both 190% incorrect in your reasoning.

    I just hope that neither one of you ever have to come across a bona-fide emergency where it is up to you to act and no one else, because trust me, your reasoning of why you can stand there and let someone die and pick and choose which parts of training you are going to use..is not going to be a valid defense in court.

    I guarantee it.
    I'm not so concerned about a valid defence in court, but a valid defence in my own self-judgement if a person died and I wasn't sure I did everything in my power to prevent that loss. I can see not stopping at accidents, and avoiding the decision, but when it jumps up in your face, I don't know how many of us could really not provide airway support- reguardless of the current position of the AHA. I still think having a little more O2 floating around in my bloodstream can't hurt if someone is in a full arrest.
  8. 2
    CPR instruction is standardized by the American Heart (& Stroke) Association. No Good Samaritin law in any State will require you to risk infectious exposure. The legislature has no right to put your health at risk. I've taught CPR since the 80's and was an Instructor Trainer at one time. Currently I am in the process of getting my Advanced Cardiac Life Support (ACLS) Instructor back. (I'm sort of coming-out of Paramedic retirement while in RN school--I plan to be an EMS Educator once again--I wish I could be a flight Medic/RN but my hip replacements limit me somewhat). The new 2010 Guidelines are changing things from ABC to CAB. This phase-in occurs during 2011. If you don't have a barrier device you are NEVER required to provide mouth-to-mouth, but you must activate EMS and do compressions--the bare minimums, once you assess the patient. Someone may want to sue you for doing an incomplete job, but they won't win, because you are protected by Good Samaritin. Let EMS handle the AB part if you are not able to protect yourself. EMS providors stopped doing mouth-to-mouth in the 80s and went to mouth-to-mask as a minimum. I got exposed to HepB and luckily I survived. Any CPR Instructor who says otherwise is in need of remediation. You must consider their experience. Some CPR Instructors have barely ever done CPR. I can assure you I've been present during several 100s of codes if not a thousand, and I have trained 100s of people in CPR.
    That Guy and ~Mi Vida Loca~RN like this.
  9. 0
    Survival rates for adult cardiac arrest without a defibrillator are indeed extremely low unless it is caused by a correctable respiratory component. But, with the typical bad heart scenario the defib window is basically 10 minutes. This is because the chance of survival decreases by 10% for each minute without defib. So the AHA would prefer you shoot for the middle of the window and defib within 5 minutes, which gives you a 50/50 chance of getting them back. Recent studies have shown that compressions and defib are more important that ventilations, so don't sweat the mouth-to-mouth. You should always use a barrier/mask/tube. I ran a Public Access Defib (PAD) program and wrote a white paper for Fire Engineering Magazine.


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