ALS Providers and AED during Cardiac Arrest

[EMSrush]

I was wondering what everyone thought about an ALS provider running an arrest with a LP 12 (or other monitor) in AED mode. Lazy? Ingenious? Something in between?

Pros and Cons?

 

[zmedic]

I was wondering what everyone thought about an ALS provider running an arrest with a LP 12 (or other monitor) in AED mode. Lazy? Ingenious? Something in between?

Pros and Cons?

The con is that you waste time with no compressions being given while the machine "thinks." I'm pretty sure I can recognize vtach faster than an AED prompts to shock.

I can't see any pros unless you don't know how to use the LP12 or can't read a shockable rhythm.

 

[NYMedic828]

I was wondering what everyone thought about an ALS provider running an arrest with a LP 12 (or other monitor) in AED mode. Lazy? Ingenious? Something in between?

Pros and Cons?

Extremely lazy and unprofessional. Shouldn't have a machine telling me "attach pads to patient bare chest" when I am expected to be a trained medical professional.

 

[firecoins]

If your patient has a bear chest, you probably shouldn't be working them.

If your monitor screen breaks, than you can switch to the and mode. Otherwise, no reason to be in aed mode.

 

[Aidey]

The pro is that if you don't have the man power for someone to keep time you still know where you are in the code. On the LP 15 the metronome option is great for that too without having to put the machine in AED mode.

 

[NYMedic828]

If someone isn't keeping time it isn't a bad idea.

As long as our monitor is on, it keeps time in one form or another... (MRX)

 

[Aidey]

LP 12s don't have a code timer, or at least none of the ones I've used have. You can look at the little clock on the screen, but if you are trying to work a code with 2 or 3 people it is really easy to lose track of time.

 

[Achilles]

If your patient has a bear chest, you probably shouldn't be working them.

.

 

[mycrofft]

Aren't you required to stop the vehicle or litter or whatever (including compressions) while the AED monitors? And if the device doesn't autoshock how does it save manpower?

 

[Clare]

I've seen it done. Getting enough people to a cardiac arrest is difficult enough as it is so if you can make better use of resources I say go for it!

Ideally one person should be assigned to watching the monitor and charging/operating the defibrillator, this is usually whomever is in charge of running the resuscitation however there are always not enough hands to do this.

Using the AED mode (for at least for the first couple of shocks) makes it much easier for whomever the most senior person is to run the resuscitation as they'll also have other things to do as well however with the progressive de-emphasis on intravenous access, IV drugs and intubation in cardiac arrest resuscitation it might not be as necessary as it was in the past.

As has already been said, there is a downside in that it takes longer to use automatic mode to analyse and shock however I doubt this will be clinically significant.

 

[EMSrush]

How about end tidal? You can't see waveform while the monitor is in AED mode.

 

[EMSrush]

LP 12s don't have a code timer, or at least none of the ones I've used have. You can look at the little clock on the screen, but if you are trying to work a code with 2 or 3 people it is really easy to lose track of time.

The LP 12 that I witnessed did have a timer in AED mode. It was a huge box that blocked nearly the entire screen while it counted down.

 

[NomadicMedic]

I've seen it done. Getting enough people to a cardiac arrest is difficult enough as it is so if you can make better use of resources I say go for it!

Ideally one person should be assigned to watching the monitor and charging/operating the defibrillator, this is usually whomever is in charge of running the resuscitation however there are always not enough hands to do this.

Using the AED mode (for at least for the first couple of shocks) makes it much easier for whomever the most senior person is to run the resuscitation as they'll also have other things to do as well however with the progressive de-emphasis on intravenous access, IV drugs and intubation in cardiac arrest resuscitation it might not be as necessary as it was in the past.

As has already been said, there is a downside in that it takes longer to use automatic mode to analyse and shock however I doubt this will be clinically significant.

I think the period of time that requires "hands off chest" or no CPR while the machine analysis occurs is significant. I can pre-charge the monitor, pause the Lucas, recognize the rhythm, shock and restart the Lucas in less than 10 seconds. That's why using the LP in AED mode is verboten at my service.

 

[Christopher]

I think the period of time that requires "hands off chest" or no CPR while the machine analysis occurs is significant. I can pre-charge the monitor, pause the Lucas, recognize the rhythm, shock and restart the Lucas in less than 10 seconds. That's why using the LP in AED mode is verboten at my service.

^- This. We pre-charge, hold compressions, analyze, shock, and resume compressions in ~5 seconds. No AED on the market currently does this.

If you're looking at ~10 seconds, then with practice you could do that with Physio-Control's and Philips' latest AED's. They all take ~9 seconds of hands-off time assuming you had Flash Gordon taking their hands off and putting their hands back on the chest...

 

[Aidey]

The LP 12 that I witnessed did have a timer in AED mode. It was a huge box that blocked nearly the entire screen while it counted down.

That was kind of my point....the only way for the LP 12 to provide a CPR timer is in AED mode. There is no timer in manual mode.

 

[EMSrush]

That was kind of my point....the only way for the LP 12 to provide a CPR timer is in AED mode. There is no timer in manual mode.

I misread. Sorry.

 

[Jon]

I've seen it done. As was said, especially at the very beginning, (before the engine full of stretcher-fetchers shows up ), it can be helpful to have the reminder to re-assess. Even if I just stop, assess, and keep going. Once the Lucas is attached and/or you have plenty of hands, it shoudn't be in AED mode.

Jon

 

[Clare]

I think the period of time that requires "hands off chest" or no CPR while the machine analysis occurs is significant. I can pre-charge the monitor, pause the Lucas, recognize the rhythm, shock and restart the Lucas in less than 10 seconds. That's why using the LP in AED mode is verboten at my service.

I understand your rationale and agree that interruptions to CPR should be a minimum. If the fastest way for the patient to be defibrillated is to the use the LP12 in AED mode then so be it and over the entire cycle of a cardiac arrest resuscitation their survival is not going to hinge on extra 10 seconds of CPR.

A curious misnomer is that those at Emergency Medical Technician (BLS) level are taught to identify VT and VF as well as monitor and acquire 12 lead ECG in manual mode but can only shock in automatic mode.

 

[Aidey]

A curious misnomer is that those at Emergency Medical Technician (BLS) level are taught to identify VT and VF as well as monitor and acquire 12 lead ECG in manual mode but can only shock in automatic mode.

This sounds like an agency specific thing. Most of the EMTs I've worked with known enough to tell a dead rhythm from a live one, but it is something they picked up along the way, not something they learned formally in class.

 

[Clare]

This sounds like an agency specific thing. Most of the EMTs I've worked with known enough to tell a dead rhythm from a live one, but it is something they picked up along the way, not something they learned formally in class.

It's always been the case that those at the BLS level can do basic cardiac rhythm monitoring they can only defibrillate in automatic mode.

I think there are probably several reasons behind it:

1) It's not really necessary, if it is deemed acceptable that somebody on the street to use an AED in a resuscitation then it's acceptable that BLS people use one.

2) It is very unlikely that a cardiac arrest will be solely managed by BLS people

3) It would increase training and risk