Jeff Clawson, M.D.

Jeff Clawson, M.D.

Ask Doc

By Jeff Clawson

Hi Brett:

While checking the ProQA Paramount logic sequences for the Unconscious Choking CPR pathway, I noticed that the protocol instructs a rescuer to do a round of compressions, then start mouth-to-mouth. However, if mouth-to-mouth is unsuccessful due to the absence of air movement in Panel C-5 (the rescuer did not feel the air going in or out), the EMD is directed to go to Panel C-9 and provide instructions for the combination of 2 breaths then 30 chest pumps. Why do we instruct the rescuer to keep attempting mouth-to-mouth instead of doing chest compressions only?


Irena M. Weight

Director of Translation, Standards, and Logic Design

Priority Dispatch Corp.

Hi Irena:

The rationale is to compress first to try and dislodge the object, which is why we reversed the ventilations/compressions sequence for the Unconscious Choking (UC) pathway in v12.2. If air does not go in when we first try to ventilate, we keep trying to ventilate after each compressions sequence, checking the mouth for an object in between attempts, with the hope of dislodging or, in desperation (for a lack of a better term), pushing the object into the right, main-stem bronchus, which would allow lifesaving ventilation of the left lung. This may happen because the right, main-stem bronchus is wider, more vertical, and has a straighter alignment to the trachea than the left bronchus. If the object can be “pushed” into the right bronchus, it can then be removed later with a bronchoscope.


Brett Patterson

IAED Academics, Standards, & Research Medical Council of Standards Chair