Full Arrest

[BEorP]

Thoughts?

Survival did not improve between the basic life support with defibrillation and the advanced life support phases. Therefore, in an EMS system that already has optimal rapid defibrillation, advanced life support interventions did not improve patient survival.

Source: http://www.chsrf.ca/final_research/ogc/stiell_e.php

 

[Ridryder911]

Nothing new, old and faulty study that did not really prove anything. That is why most never have heard or cite it anymore. It was a very large and well documented study in fact the inner saying it was way over done. The only real point that was brought out was that it offered unrealistic suggestions (always having BLS within four minute response time).


If one has a cardiac arrest, the numbers have always demonstrated if one has arrested the chances of survival is dismissal.

R/r 911

 

[boingo]

With more ALS providers initiating therapeutic hypothermia in ROSC we might find that ALS isn't as useless as they'd have you believe....time will tell.

 

[evantheEMT]

I just shake my head at the training or lack of training in emt school.When I did my emt school 6 yrs ago we went into depth about everything. The instructors didnt just say we do this because of protocols but instead this is why we do it this is what the body is doing at the time of whatever is going on.

 

[vcuemt]

I just shake my head at the training or lack of training in emt school.When I did my emt school 6 yrs ago we went into depth about everything. The instructors didnt just say we do this because of protocols but instead this is why we do it this is what the body is doing at the time of whatever is going on.

Back in my day, I walked uphill both ways to EMT school in the driving snow with only a baked potato in my pocket to keep me warm and feed me.

 

[avdrummerboy]

So how much more likely is a patient to live when they get ALS rather than BLS treatment for their cardiac arrest?

I've had this argument many a time, BLS will save just as much life as ALS. Give me 2 EMT-B's and an AED and associated BLS gear and they'll get ROSC just as likely as two ALS providers with their associated gear will! Say what you will, but 2 well trained EMT's who know how to run a BLS full code can easily get ROSC or get moving to an ALS hospital which is arguably a slightly better working environment than the pt.'s bathroom floor.

Sure rapid ALS measures are helpful, but unless you have a 15+ minute transport time, there is nothing that you are going to do in the field that isn't going to be done in the hospital or vice versa- also the reason that no ALS system that I know of considers a full code a load and go rapid transport.

A paramedic is only going to shock the same rhythms that an AED will, sure they can ""maybe"" get a tube (or go with a king or LMA, also nationally a basic skill) and there are some drugs that can be given, and folks can let loose on their feelings of epi in cardiac arrest!

So the argument that ALS needs to be everywhere all the time is total crap, do we need to rehash the studies of the quality of pt. care with multiple ALS providers on scene?

 

[TransportJockey]

I've had this argument many a time, BLS will save just as much life as ALS. Give me 2 EMT-B's and an AED and associated BLS gear and they'll get ROSC just as likely as two ALS providers with their associated gear will! Say what you will, but 2 well trained EMT's who know how to run a BLS full code can easily get ROSC or get moving to an ALS hospital which is arguably a slightly better working environment than the pt.'s bathroom floor.

Sure rapid ALS measures are helpful, but unless you have a 15+ minute transport time, there is nothing that you are going to do in the field that isn't going to be done in the hospital or vice versa- also the reason that no ALS system that I know of considers a full code a load and go rapid transport.

A paramedic is only going to shock the same rhythms that an AED will, sure they can ""maybe"" get a tube (or go with a king or LMA, also nationally a basic skill) and there are some drugs that can be given, and folks can let loose on their feelings of epi in cardiac arrest!

So the argument that ALS needs to be everywhere all the time is total crap, do we need to rehash the studies of the quality of pt. care with multiple ALS providers on scene?

Unless you have some kind of mechanical CPR device, transporting a working code is putting the public at risk and completely killing any chances at ROSC that the patient might have had. No one can do proper CPR in a moving ambulance.

 

[Tigger]

Post ROSC care is decidedly not a "BLS" skill.

 

[Handsome Robb]

Therapeutic Hypothermia isn't doing as great as they thought it would. A recent study showed no difference between 32 and 36* C in survival to discharge.

I'm too lazy to find it right now but I will tomorrow after I've slept.

 

[avdrummerboy]

Unless you have some kind of mechanical CPR device, transporting a working code is putting the public at risk and completely killing any chances at ROSC that the patient might have had. No one can do proper CPR in a moving ambulance.

Hence the reason full arrests are not load and go calls, a) there's nothing that the hospital will do that you won't in the field (in an ALS system) and b) it's pretty sh***y CPR in the back when on the go.

My post about BLS saving just as much life as ALS has nothing to do with post ROSC care, that area has enough unknowns as it is. ALS interventions ASAP when ROSC is achieved is indeed needed, my point was that calling an ALS intercept unit is feckless unless you're 15+ minutes out and can be met on the way, otherwise, why waste the time? By the time you intercept, transfer the patient, start a line, push a med or two and hope that all the shuffling around doesn't put the pt. back into full arrest, you could have been at the hospital and done the same things there (which by coincidence is where the ALS unit would be going anyway!)

 

[MonkeyArrow]

I believe @Handsome Robb is referring to the TTM trial. http://www.nejm.org/doi/full/10.1056/NEJMoa1310519
However, I think I read somewhere on one of these critical care podcast/website thingies that temperature management is still important to prevent the patient from actually getting hyperthermic and developing a fever, which can be deadly. In order to keep the temperature at normal body levels, you may actually have to utilize active cooling measures. I also think it said somewhere that there is a difference between inducing hypothermia intra-arrest vs post-arrest ROSC care phase.

 

[John E]

I miss Ridryder...

 

[TransportJockey]

I miss Ridryder...

You're not the only one. But I do see some days why he gave up on the forum

 

[usalsfyre]

Hence the reason full arrests are not load and go calls, a) there's nothing that the hospital will do that you won't in the field (in an ALS system) and b) it's pretty sh***y CPR in the back when on the go.

My post about BLS saving just as much life as ALS has nothing to do with post ROSC care, that area has enough unknowns as it is. ALS interventions ASAP when ROSC is achieved is indeed needed, my point was that calling an ALS intercept unit is feckless unless you're 15+ minutes out and can be met on the way, otherwise, why waste the time? By the time you intercept, transfer the patient, start a line, push a med or two and hope that all the shuffling around doesn't put the pt. back into full arrest, you could have been at the hospital and done the same things there (which by coincidence is where the ALS unit would be going anyway!)

You are a great example of "you don't know what you don't know"

Let me present you with a few scenarios. I'd like to know your BLS response to each one.

The local ED is incapable of PCI, do you divert or go to the local with your ROSC patient?

Your ROSC patient converts into a bradycardiac rate in the 30s and is severely hypotensive. How do you deal with this in a 10 min transport?

Your ROSC patient missed his dialysis appointment yesterday. Any thoughts?

You can get ROSC as well as a medic.....BFD. Don't let overconfidence cloud your judgement on appropriate management, which an EMT can't provide.

 

[vcuemt]

Most people who go into cardiac arrest are ending up dead, short term or medium term. Let us not forget that. Run all the scenarios you want.

 

[Bullets]

As i first read this thread i couldnt believe how many people were talking about using the FD to assist with moving and transporting and high flow diesel.

Then i saw it was a thread from 2008....im sure this was worth the bump

 

[avdrummerboy]

You are a great example of "you don't know what you don't know"

Let me present you with a few scenarios. I'd like to know your BLS response to each one.

The local ED is incapable of PCI, do you divert or go to the local with your ROSC patient?

Your ROSC patient converts into a bradycardiac rate in the 30s and is severely hypotensive. How do you deal with this in a 10 min transport?

Your ROSC patient missed his dialysis appointment yesterday. Any thoughts?

You can get ROSC as well as a medic.....BFD. Don't let overconfidence cloud your judgement on appropriate management, which an EMT can't provide.

Alright, here we go...

Question one, in my area, you go local as the next nearest is 35+ min away even code 3!

Question two, big whoop, haul ***, by the time you intercept, drop a line, administer fluids and push atropine, you could have been at the hospital and had them doing it (again that is where the ALS unit would be taking them anyway!) In terms of BLS, monitor vitals and keep a good airway!

Question three, even at the ALS level you're merely guessing at how off K+ levels are anyway, unless of course in that 10 minutes the ALS unit is running blood tests and getting those results. That being said, BLS airway and vitals monitoring and know that the chances of a reoccurring arrest are fairly high.

As was mentioned above, VERY few cardiac arrests waltz out of the hospital later on, regardless of how many ALS providers were on scene initially. The vast majority of them don't make it, or get to live life as a vegetable until the family or legal guardian cannot bear to see it anymore.

 

[Chewy20]

As i first read this thread i couldnt believe how many people were talking about using the FD to assist with moving and transporting and high flow diesel.

Then i saw it was a thread from 2008....im sure this was worth the bump

Not sure if you are just referring to them doing a load and go, or having FD assist period on scene.

 

[usalsfyre]

Alright, here we go...

Question one, in my area, you go local as the next nearest is 35+ min away even code 3!

Question two, big whoop, haul ***, by the time you intercept, drop a line, administer fluids and push atropine, you could have been at the hospital and had them doing it (again that is where the ALS unit would be taking them anyway!) In terms of BLS, monitor vitals and keep a good airway!

Question three, even at the ALS level you're merely guessing at how off K+ levels are anyway, unless of course in that 10 minutes the ALS unit is running blood tests and getting those results. That being said, BLS airway and vitals monitoring and know that the chances of a reoccurring arrest are fairly high.

As was mentioned above, VERY few cardiac arrests waltz out of the hospital later on, regardless of how many ALS providers were on scene initially. The vast majority of them don't make it, or get to live life as a vegetable until the family or legal guardian cannot bear to see it anymore.

OOOORRRR, you can recognize the guy with a whopping 200 hours of advanced first aid MIGHT be in WAY, WAY over his head, assign units to a cardiac arrest call appropriately in the first place, and increase the chances of your patient not ending up a vegetable.....

I'm a cynic about ICU care and OOHCA. But your attitude downright sucks.

 

[gotbeerz001]

Alright, here we go...

Question one, in my area, you go local as the next nearest is 35+ min away even code 3!

Question two, big whoop, haul ***, by the time you intercept, drop a line, administer fluids and push atropine, you could have been at the hospital and had them doing it (again that is where the ALS unit would be taking them anyway!) In terms of BLS, monitor vitals and keep a good airway!

Question three, even at the ALS level you're merely guessing at how off K+ levels are anyway, unless of course in that 10 minutes the ALS unit is running blood tests and getting those results. That being said, BLS airway and vitals monitoring and know that the chances of a reoccurring arrest are fairly high.

As was mentioned above, VERY few cardiac arrests waltz out of the hospital later on, regardless of how many ALS providers were on scene initially. The vast majority of them don't make it, or get to live life as a vegetable until the family or legal guardian cannot bear to see it anymore.

1. How old are you?
2. Since you seem to be so knowledgable, are you working towards your PA (or some other advanced license) with which you will actually effect positive outcomes? Or is being a self-righteous overly-skilled taxi driver actually doing it for you?