Putting AED, CPR, Intubation Together

[WuLabsWuTecH]

also, without getting too far ahead, it is important to understand the hemodynamics of CPR first...

for example, during compressions, not that much blood is pumped out... the hemodynamic principal of negative intrathoracic pressure has been proven to be the most important, and least understood. basically, the upstroke cycle of CPR is what helps perfusion the most, increasing preload and filling chambers...

also, understanding things like why you don't do compressions if an arrest is witnessed, but why you do at least 2 minutes if it isn't... why compressions are more important then ventilations, what happens when you interrupt the compression cycle, etc...

Some EMT's take CPR for granted because the chances for saving someone are slim to begin with... others take it for granted because they don't know any better...

if you really want to know how to do it correctly, have a real working knowledge not of the steps, but "why" the steps.

They why you do 2 minutes of CPR first is to ensure adequate oxegenation. When you defib, you try to get the heart to stop firing randomly, and hope that it resets itself into firing in a synch'd pattern. What happens is that the myocardium is a special muscle that can cause electrical impulses w/o the brain through various uses of nodes. Anyway, it has a better chance of resetting itself when its oxegenated. If you see the guy fall, he was breathing just a second ago so it shuold be oxygenated. If you arrive on scene, he may have gone w/o oxygen for 5 minutes. If old-school (January 2008 style) bystander CPR in progress and you think he is adequately oxygenated, then go ahead and defib. If new-school "compressions only" CPR in progress, Take over and do Real CPR for 2 minutes to oxygenate the myocardium.

Am i correct?

 

[MRE]

They why you do 2 minutes of CPR first is to ensure adequate oxegenation. When you defib, you try to get the heart to stop firing randomly, and hope that it resets itself into firing in a synch'd pattern. What happens is that the myocardium is a special muscle that can cause electrical impulses w/o the brain through various uses of nodes. Anyway, it has a better chance of resetting itself when its oxegenated. If you see the guy fall, he was breathing just a second ago so it shuold be oxygenated. If you arrive on scene, he may have gone w/o oxygen for 5 minutes. If old-school (January 2008 style) bystander CPR in progress and you think he is adequately oxygenated, then go ahead and defib. If new-school "compressions only" CPR in progress, Take over and do Real CPR for 2 minutes to oxygenate the myocardium.

Am i correct?

Sounds good. Automacity is a neat thing.

I hope the compression only CPR hasn't taken over that much.

After a long day at work and a long squad meeting, I checked my books. The Basic book does mention 2 min of CPR before sparking the PT in one place in the text and in one of the little side boxes. Not visible enough in my opinion.

The ARC Pro Rescuer CPR does not mention it anywhere in the standalone book. Instructions are to apply pads and spark as soon as AED becomes available.

Turns out I don't have a standalone AHA BLS book, so I can't check that.

Going back to the original question/disagreement, I was incorrect and you should do 2 min of CPR prior to using the AED. We should probably try to get this thread back on track now. Phew.

 

[Jon]

Sounds good. Automacity is a neat thing.

I hope the compression only CPR hasn't taken over that much.

After a long day at work and a long squad meeting, I checked my books. The Basic book does mention 2 min of CPR before sparking the PT in one place in the text and in one of the little side boxes. Not visible enough in my opinion.

The ARC Pro Rescuer CPR does not mention it anywhere in the standalone book. Instructions are to apply pads and spark as soon as AED becomes available.

Turns out I don't have a standalone AHA BLS book, so I can't check that.

Going back to the original question/disagreement, I was incorrect and you should do 2 min of CPR prior to using the AED. We should probably try to get this thread back on track now. Phew.

I got my peepee smacked last time I co-taught an AHA HCP class... because I talked about CPR before AED in unwitnessed arrests.

AHA doesn't teach this (Yep... I checked, and I've got the BLS Instructor card, too). Some EMS services have it in protocols.

 

[WuLabsWuTecH]

Well when you have that many organizations trying to teach CPR, you're bound to have conflicting opinions or at least disagreeing opinions. Probably due ot everyone's different research?

 

[ffemt8978]

I got my peepee smacked last time I co-taught an AHA HCP class... because I talked about CPR before AED in unwitnessed arrests.

AHA doesn't teach this (Yep... I checked, and I've got the BLS Instructor card, too). Some EMS services have it in protocols.

Pg 35 of the most recent BLS for HCP Student Manual under EMS Rescuers and AEDs

EMS rescuers may provide 5 cycles of CPR before using the AED if they did not witness the cardiac arrest and their call to arrival time is more than 4 to 5 minutes.

 

[firecoins]

The only times I have seen the 2 min of CPR mentioned in an unwitnessed arrest (or a child/infant) is when a single person finds the victim and needs to leave to call 911. They do 2 min of CPR, leave to call 911 and return. In a witnessed arrest of an adult, they call and then provide care.

I can't recall ever seeing it mentioned with an AED. I believe it always says that the AED should be attached as soon as possible, which usually means that one person begins CPR and the other prepares the AED.

I'm at work right now, but I will pull out the ARC and AHA CPR literature when I get home tonight and double check.

Also, please remember I am talking about what is taught in CPR classes only, and not modifications or additions to those skills done in EMT/Medic/ACLS classes.

i have seen 2 minutes of CPR on unwitnessed arrests in everything I have read.

 

[skyemt]

i have seen 2 minutes of CPR on unwitnessed arrests in everything I have read.

2 minutes of CPR is on everything i have read as well, including my AHA materials...

basically, if someone is down for 5 minutes or more, and you go right to shocking, it will be a speedy way to make sure they will not make it.

there seems to be a lot of focus on "oxygenation", which is partially true, but what you are really after is "perfusion pressure" and adequate preload, which go together...