Restricted Space

Especial in the diving bell. Many Closed Bell divers have been instructed in alternate techniques of chest compression whilst in a bell. Several variants involve chest compressions whilst the victim is in a vertical position. There is a ‘head butting techniques’ & a ‘kneeing’ technique. Medically these make little logical sense. These techniques evolved when 2 man bells were common and there was little other option. The real aim with cardiac massage is to gat an effective cerebral perfusion. The normal cardiac output is 5-6 litres per minute. In the critically ill this is measurable with intra-arterial lines. When resuscitation is given, the best cardiac output achievable with a casualty, horizontal, with a firm board behind them, is 2-3 litres Cardiac Output. Therefore cardiac massage in a vertical victim would achieve virtually no cerebral perfusion… which is the whole aim of CPR. We have discovered in hospital resuscitations however, that if a horizontal casualties legs are vertically elevated, the C.O. can increase to 3-4 litres / min. This has profound implications for bell resuscitations. In modern 3-4 man bells with a lateral access door it can be possible to lover the victim to the floor & place there legs up the bell wall.

Available ppO₂

OK… a casualty has 6-10 minutes with no resuscitation or they are ‘brain dead’… There are two factors; temperature and ppO₂. We have discussed cold.

The 6-10 minutes without resuscitation is for a normobaric casualty. with a ppO₂ of 210 mbar. In the diving world these are increased & cerebral metabolic survival is possible for longer.

• ppO₂ in Saturation                400 mbar = 15-20 minutes
• ppO₂ in Bell                           600 mbar = 25-30 minutes
• ppO₂ in Diving excursion      700 mbar = 30-35 minutes
• ppO₂ in bail-out                    1600 mbar max = > 70 minutes (keep in mind this will be combined with acute hypothermia)

So. it is important that divers are proficient at CPR. It is also important that they are aware of the key differences when dealing with divers.

The use of effective teamwork is an important factor. This is something that is a key feature on your course at TRAUMA Training.

It must be understood the Basic Life Support  is a holding action. Fundamentally the main purpose of CPR is to provide early access to defibrillation.

It must be understood the Basic Life Support  is a holding action. Fundamentally the main purpose of CPR is to provide early access to defibrillation.