First Aid Myths

CPR

You don’t have to give breaths

You don’t, but it’s best if you do. The Australian Resuscitation Guidelines say that if you’re trained and willing you should. The blood in our body only contains so much oxygen, if we were to do compression only CPR, we’ll soon run out of oxygenated blood being pumped around. If you were to do compression only CPR on a casualty who has drowned, you would be pumping deoxygenated blood around and it’d be pointless. Same deal for a baby, who has a very high oxygen demand and very low blood volume. This will be the topic of a future blog as it seems to cause a lot of confusion.

Just a puff out of your cheeks for baby CPR

I challenge anyone to tell me exactly how much air is in your cheeks when you puff… It’s simple for this one, put just enough air in to make the chest rise. Works on adults, children and babies, no need to worry about how much air is in your cheeks.

Encircling the chest of the baby when doing compressions

Although using thumbs as an alternative method of providing chest compressions on an infant may be acceptable if the rescuer is unable to get the correct chest depth using their fingers, encircling the chest with the hands It’s not a technique that should be used by lay responders. Supporting the back with the fingers is reasonable but be mindful not to squeeze the infant from both sides. Problems that can occur when a lay rescuer performs this incorrect compression technique include squashing the chest cavity (rather than focussed pressure on the lower half of the sternum) and failing to allow the chest cavity to expand when breaths are given in two-person CPR. You may witness Health Care Professionals with appropriate Advanced Life Support training demonstrate this skill, but as a general rule in the first instance, attempt infant chest compressions with two fingers while supporting the head in a neutral position.

Picking the baby up to do compressions on your arm

This one crops up a lot on courses and is not correct. By picking up a baby and doing compressions on your arm (or in your lap), you are unable to get the correct depth of compressions. You’re also unable to effectively support the baby’s head. Finally, when holding the baby in your arm doing CPR, you’re going to get a very tired and sore arm. The best technique is to place the baby on a firm surface (the ground or on a table/bench), hold the head of the baby in the neutral position and commence compressions using two fingers in the centre of the chest (lower half of the sternum).

Use the patients fingers to scoop out what’s in their mouth

When you’re unconscious, all the muscles in your body relax. This is why we must position an unconscious patient on their side with their head back and face down, so as not to let the tongue and other upper airway anatomy block the airway. If all muscles are relaxed, the effectiveness of using a patients’ own fingers to clear their airway would be about as effective as shooting pool with a length of rope. It’s just not going to happen. Take the appropriate standard precautions for infection control (i.e. gloves), use your own fingers and scoop the goop or flick the sick. If it looks like they’re seizing, don’t put your fingers in there, just wait until the seizing is finished.

Choking

Use the Heimlich Manoeuvre

Taught in America and advocated in their guidelines, the Heimlich Manoeuvre (aka abdominal thrusts) has been deemed too high risk by the Australian Resuscitation Council and should therefore not be used and definitely not taught. There are too many highly vascularised organs under the lower ribs/upper abdominal region that could be damaged if performed incorrectly and there are in fact documented cases of life threatening complications when this technique has been used.

Dangerous bleeding

You can’t use a tourniquet

A hangover from older first aid courses, I remember being taught this years ago. However, much research and hard-won experience on the battlefields of Iraq and Afghanistan, not to mention mass casualty events such as the Boston Marathon bombings and the Sandy Hook Massacre in the USA, have proven the effectiveness of the tourniquet. A recent study in Texas, USA showed that the civilian application of the tourniquet for dangerous vascular bleeding gave almost a six times greater chance of survival than for those who didn’t get one applied. Quite simply, they save lives. Read up on my previous blog introducing the ‘Stop the Bleed’ workshop that we run – https://www.paradisefirstaid.com.au/stopping-the-bleed/

If you use a tourniquet, you have to take it off after x amount of time

Again, another hangover from older first aid courses. This is a technique taught at higher levels of pre-hospital care when there is an extended transportation time. This is not something that we do at our level.

You need to elevate the limb

For an arterial bleed, this technique is ineffective. Let’s face it, the blood pumps uphill from our heart to our brain. Stands to reason that if we held an arm that had an arterial bleed above our heart, it’s going to pump all the way up there too. There is no evidence to say it works, in fact it has shown to cause further injury. The correct techniques are taught in our first aid courses, the ‘Stop the Bleed’ workshops or in the same blog as mentioned above in tourniquets.

Embedded Object

Use a donut bandage

An antiquated technique that simply doesn’t work. For starters, it takes a long time to make (and if you’ve pre-made them, it takes up a hell of a lot of room in your first aid kit). Secondly, they only go on a nice and straight embedded object. Thirdly, you’d have to be pretty damn lucky (or unlucky?) to have the embedded object the perfect size of the pre-made donut bandage. Fourthly, it won’t go on if it’s an uneven shaped object that has embedded into you (say a pair of scissors for example). Finally, it doesn’t provide the pressure at the base of the embedded object, the whole point of the exercise.

A triangle bandage wrapped around the base of the embedded object and bandaged in place is very quick and does the job. Even quicker, two rolled bandages either side of the embedded object and bandaged in place is effective.

Burns

Use butter/pawpaw cream/egg white/toothpaste

Please. Don’t. Cool running water for 20 minutes. Follow that up by placing cling wrap, or a wet absorbent dressing, or a burnaid dressing on the burn. You can read a whole lot more about burns here – https://www.paradisefirstaid.com.au/first-aid-for-burns/

Crush Injury

Don’t move what’s on them/Don’t move it after x amount of time

Another hang up from older first aid courses where there was no definitive guideline. Current best practice is to remove the crushing force ASAP, regardless of how long it has been there. Treat any external bleeding, reassure whilst waiting for ambulance to arrive. Due to a number of factors, such as potential hypothermia, hidden dangerous bleeding as well as the standard airways and breathing, the patient should be exposed from under the crushing force as soon as possible, regardless of how long they have been subjected to the crushing force.

Spinal Injury

You can’t move them

If the patient is conscious, breathing and lying on their back, then sure, leave them be. However, if they’re unconscious and breathing, they must be placed on their side in the recovery position. It’s all about life over limb, and the guidelines clearly state that airway has precedence over everything else (with the exception of dangerous bleeding). Because when we’re lying on our back unconscious, all muscles, including the tongue and other upper airway anatomy, actually drop back and block the airway. So we’d die. Do your best to roll the patient safely using the spinal log roll. But if you are on your own with your patient, roll them the best way you can.

The research I’ve done basically says that you’ll have an initial injury that may not produce paraplegia. However, secondary spinal cord injury does occur in the hours to days following the initial injury. This can be attributed to processes at a cellular level, such as hypoxia, inflammation and cell death. Nothing of which we can control at a first aider level. So please, if you come across an unconscious and breathing patient, place them in the recovery position. Or if they are still in a car following a crash, support their head in an upright position to maintain a clear and open airway.