Mouth to mouth without barrier?

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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 is required to do mouth to mouth if they don't have a barrier (mask or other device) and that he wouldn' t. I understand that the point is to at least buy the individual a couple of more minutes - that at least getting compressions going is better than people not getting involved for fear of having to do mouth to mouth.

The instructor asked the class (13 people) to raise our hand if we would be willing to do mouth to mouth on an unknown person if a barrier device is not available. When the proposed patient was a 5 year old half the class said they would be willing. When the patient was a 55 year old I was the only one that stated I would be willing to do mouth to mouth without a barrier.

I understand the risks of disease transmission. I simply don't know that I could live myself if the person died (or worse) and I had chosen to do compressions only.

So my question to others is . . . am I alone?

Specializes in NICU, Post-partum.
http://www.policeone.com/health-fitness/articles/3440667-Cop-dies-of-infection-after-CPR-with-baby/

Stories like this one are incredibly heartbreaking, and I would never risk my own life by doing CPR without a barrier. For that reason, I walk around with CPR masks and a barrier...I have an adult mask, infant mask and also just a cheap breathing barrier in the same bag that I wouldn't use b/c I have the masks with the one way valve.

So if you were in a crowded movie theater and saw someone having a heart attack, you would just stand there and let them die because you didn't have a barrier?

That is why they call it a life-or-death emergency. Sometimes things are not perfect but when we enter the profession, it is an ethical and moral responsibility to act when the situation arises and we are the only ones that can help.

God, help this world..

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Specializes in NICU, Post-partum.
I always carry a barrier with me but my CPR instructor said that healthcare workers are supposed to still do breaths but not the general public. She also said that if some were worried about mouth to mouth then rip a small whole in a piece of cloth (shirt or whatever is available) and do breaths. I think I probably would do respirations but I don't know for sure since I have never been in that situation.

Many people are still not understanding this simple clarification..I'm glad you do.

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So if you were in a crowded movie theater and saw someone having a heart attack, you would just stand there and let them die because you didn't have a barrier?

That is why they call it a life-or-death emergency. Sometimes things are not perfect but when we enter the profession, it is an ethical and moral responsibility to act when the situation arises and we are the only ones that can help.

God, help this world..

You can act without risking your life.

I would do compressions only until paramedics arrived if I had no barrier. If I had a barrier (which I do, as I've stated I carry two masks and a barrier in a small red bag in my purse), then I would give breaths. At no time would I put myself at risk of contracting a disease. There is no way for me to know what that person lying on the floor is infected with.

The police officer in the story I posted lost his life contracting an infection from giving CPR to an infant. I think that should be a wake up call to all healthcare personnel to carry barriers so that not having a barrier doesn't have to be an issue. The keychain barriers cost a few dollars, if that.

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Specializes in Infectious Disease, Neuro, Research.

Oh, I'd say Hep falls under "highly transmissable" and "very common". This is basic triage- the most help to the most viable. Healthcare providers (myself included)are consumable, limited, resources. Its inspiring, noble and all that other wonderful stuff, to say that we would absolutely risk it all to save that poor soul who_____. But. It should be a considered move. Following emotion without reason is as deadly and destructive as reason without emotion.

To directly answer the question: I would be doing a hard core SES/psycho-social assessment before I would go "all bare-back".

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I have been asking myself the same question. I have decided to buy a barrier to carry around with me just in case I am ever in this situation. Personally, I wouldn't want to do CPR on anyone without a barrier. You just never know. You have to protect yourself as well.

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Specializes in SICU.

As someone that works in an ICU I have taken people off vents after being declared brain dead. Once off the vent it has taken sometimes over 10 minutes before that pulse ox has dropped below 90% and 15-20 before the pulse ox was below 60%. Unless the victim is a child it is most likely that it is cardiac related and they will have adequate oxygenation prior to the arrest. They will have enough oxygen to last until paramedics can get there.

Another point is that of the 30 compressions only about the last ten have enough pressure to actually circulate blood. Every time you stop compressions to give breaths you are stopping circulation a lot more than most people think. If you don't have a barrier do continous comprssions, save the victim and yourself.

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Oh, I'd say Hep falls under "highly transmissable" and "very common". This is basic triage- the most help to the most viable. Healthcare providers (myself included)are consumable, limited, resources. Its inspiring, noble and all that other wonderful stuff, to say that we would absolutely risk it all to save that poor soul who_____. But. It should be a considered move. Following emotion without reason is as deadly and destructive as reason without emotion.

To directly answer the question: I would be doing a hard core SES/psycho-social assessment before I would go "all bare-back".

Also tuberculosis, bacterial menengitis and others.... I live in a major metropolitan city and TB is so common they've identified high-risk zip codes. I'm a volunteer CPR instructor and was extremely happy when our curriculum got switched to "hands-only" without a barrier. I would not feel comfortable suggesting to people taking the course that they "would probably be okay" coming in contact with the saliva and vomit of someone they don't know, b/c its just not true.

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I wouldn't for 2 reasons. First reason is its unsafe (for me) and my safety is #1. Second reason is success rate is extremely low, something like less than 5% survive without a AED.

most cardiac will vomit -bloody vomitus no less, so safety is not to be taken lightly. hep C is a big deal.

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Many people are still not understanding this simple clarification..I'm glad you do.

I did not misunderstand what was being taught. Just took the class. We were expressly told we do not have to do rescue breathing if we don't want to but yes of course the ideal recommendation is to do the normal pattern of 2 breaths to 30 compressions. This is after you do the first 100 compressions and you have chosen to do the breaths. If you choose not to do the breaths you just do round of 100 compressions between vital checks.

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It's better to NOT stop to do breaths and just continue compressions. Research has shown that most ppl who are doing breaths aren't doing them adequately enough to make a difference - it's better to keep the O2 in the system circulating - henced the revised methodology. So germs and exposures aside - if you see someone go down or you know they went down in the last minute or so, just do compressions (per AHA).

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As someone that works in an ICU I have taken people off vents after being declared brain dead. Once off the vent it has taken sometimes over 10 minutes before that pulse ox has dropped below 90% and 15-20 before the pulse ox was below 60%. Unless the victim is a child it is most likely that it is cardiac related and they will have adequate oxygenation prior to the arrest. They will have enough oxygen to last until paramedics can get there.

Another point is that of the 30 compressions only about the last ten have enough pressure to actually circulate blood. Every time you stop compressions to give breaths you are stopping circulation a lot more than most people think. If you don't have a barrier do continous comprssions, save the victim and yourself.

Thank you for this. I had asked about this but didn't get an answer.

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Specializes in NICU, Post-partum.
You can act without risking your life.

I would do compressions only until paramedics arrived if I had no barrier. If I had a barrier (which I do, as I've stated I carry two masks and a barrier in a small red bag in my purse), then I would give breaths. At no time would I put myself at risk of contracting a disease. There is no way for me to know what that person lying on the floor is infected with.

The police officer in the story I posted lost his life contracting an infection from giving CPR to an infant. I think that should be a wake up call to all healthcare personnel to carry barriers so that not having a barrier doesn't have to be an issue. The keychain barriers cost a few dollars, if that.

If you were a licensed healthcare professional, you would not have a choice.

The law requires you to function, IF you choose to get involved, to your "highest level of training". The standard of CPR has changed for laypersons to chest compressions only, however, like the other poster said, rescue breaths are still required to be delivered by licensed professionals whether an abu-bag is available or not...barrier or not.

If you are a CPR instructor, I am very, very surprised you do not know that.

The fact that you live in a large city, is not going to help you in a court case from liablility when you become licensed.

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