# Maybe we should change CPR back to A-B-C....



## Aidey (Mar 3, 2012)

http://usnews.msnbc.msn.com/_news/2012/03/01/10550666-navy-doctors-save-mans-life-on-texas-flight




> Despite two failed CPR attempts, and an unsuccessful administering of an  automated external defibrillator (AED), the man was still not  responding. A nurse on the plane tried to inject an IV line with  epinephrine, but the man's veins were inaccessible.
> 
> Finally, the two Navy doctors tried an *unconventional  trick*. The man's wife revealed her husband had a history of airway  obstruction." Capra *thrusted the man's jaw upward and opened his airway,  while Ambrosio inserted a plastic hook-shaped device into his throat.*



Emphasis added.


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## Handsome Robb (Mar 3, 2012)

So they did a modified jaw thrust and placed an OPA and all of the sudden they get ROSC? 

If you start changing it back to ABC it's just going to confuse all the newbies again


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## Aidey (Mar 4, 2012)

Yup, that is what it sounds like. I almost literally facepalmed when I read this.  Hands only CPR is fine for laypeople while waiting for EMS. But when you're 30,000 feet in their air, there is no EMS, so someone should probably take care of the airway....just sayin.

My guess is the guy is bigger and has obstructive sleep apnea. He dozes off, goes apneic, arrests and they lay him flat, further compounding the obstruction. If he had any alcohol or took a sedative for the flight that would increase the risk of having sleep apnea. Once they open his airway and he gets some oxygenation going his heart stops freaking out and starts working again. There is a reason hypoxia is one of those Hs.


Edit - I also LOVE how it took both MDs to insert the OPA!


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## firetender (Mar 4, 2012)

*Hadn't thought of this one!*

In a lot of ways this business about immediate compressions and only compressions means that no one will really be checking for potential airway obstructions and other pertinent causative factors. That's REALLY cookbook!

There used to be a sort of decision tree that you went through before initiating CPR which took into account factors other than, "Well, he's down isn't he? Let's start compressions."

I'd rather have a medic take a few seconds to evaluate the cause of my hitting the floor before initiating compressions. If I have a pulse, I want someone to know it's there before the machines come in. I want that hot dog out of my trachea NOW!

Somehow, this thread makes me wonder a little if simplifying the process doesn't place more people at risk. If any idiot can do it, then too many idiots will.


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## Mountain Res-Q (Mar 4, 2012)

firetender said:


> That's REALLY cookbook!


 
<grumble> <grumble> "I've been doing this for 400 years and I prefer to play it safe.  You youngins throw that word around too much.  I prefer cookbook and following the rules so that I can preserve my license."  <grumble> <grumble>  



firetender said:


> If any idiot can do it, then too many idiots will.



And the EMT Certs just keep on being printed out like monopoly money!  :sad:


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## socalmedic (Mar 4, 2012)

"...after two failed attempts at CPR..."

I think the bigger question here is how do you fail at CPR, TWICE!!! even LAcoFD firemen can do it right.


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## bigbaldguy (Mar 4, 2012)

Aidey said:


> Yup, that is what it sounds like. I almost literally facepalmed when I read this.  Hands only CPR is fine for laypeople while waiting for EMS. But when you're 30,000 feet in their air, there is no EMS, so someone should probably take care of the airway....just sayin.
> 
> My guess is the guy is bigger and has obstructive sleep apnea. He dozes off, goes apneic, arrests and they lay him flat, further compounding the obstruction. If he had any alcohol or took a sedative for the flight that would increase the risk of having sleep apnea. Once they open his airway and he gets some oxygenation going his heart stops freaking out and starts working again. There is a reason hypoxia is one of those Hs.
> 
> ...



Anybody get an airline on that?


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## Aidey (Mar 4, 2012)

socalmedic said:


> "...after two failed attempts at CPR..."
> 
> I think the bigger question here is how do you fail at CPR, TWICE!!! even LAcoFD firemen can do it right.




Just think about TV CPR. They do it for 10 seconds and then check and see if it worked before crying out" Live dammit, live!".

I also can't find an airline in any of the news articles. A quick search shows that American Airlines and US Airways operate the majority of the flights between San Diego and San Antonio.


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## SoCal911 (Mar 4, 2012)

socalmedic said:


> "...after two failed attempts at CPR..."
> 
> I think the bigger question here is how do you fail at CPR, TWICE!!! even LAcoFD firemen can do it right.



MOST of them can, I've met a couple that needed mid-arrest lessons.


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## Outbac1 (Mar 4, 2012)

A-B-C or C-A-B  still does not negate:

"Search for and treat possible causes
- hypovolemia, hypoxia, hydrogen ion-acidosis, hyper/
hypokalemia, hypothermia - tablets (OD), tamponade
(cardiac), tension pneumo,
thrombosis (coronary, pulmonary)"
 This from our protocols.


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## Shishkabob (Mar 4, 2012)

Even taking in to account the idiot doing the reporting for the article, they've got to be some baby docs that have little to no experience in cardiac arrests.


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## Veneficus (Mar 4, 2012)

Calling out ABC, CAB, and other memory aides for people who need them to assess a patient...

You know what I look for first?

Breathing...

Because I can see it from the door if there is adequete chest rise and fall.

I can see from the door if it is absent as well as gross quality. 

If the patient is not breathing, from signs like absence of chest rise, cyanosis, etc, I think it is safe to assume there is no pulse. But then I check anyway. 

There are also a host of other things that need to be determined, like obvious signs of death, health status, DNRs, etc, etc.

Nobody gets bent out of shape that I didn't specifically follow an ABC or CAB or BCA or whatever.

If the job gets done in a timely and efficent manner, it doesn't matter the order.


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## Pavehawk (Mar 4, 2012)

socalmedic said:


> "...after two failed attempts at CPR..."
> 
> I think the bigger question here is how do you fail at CPR, TWICE!!! even LAcoFD firemen can do it right.



What I'm sure they mean here is ... "They did two rounds of compressions but the victim didn't wake up and talk like they do on TV"

TV and movies contribute to the fallacy that CPR and defibs work all the time. You hardly ever see a person not come back and often they come back, wake up, chat, and in the case of James Bond (Casino Royale) go back and kick some ***!

Most lay people can not be expected to understand that this (CPR) is not a done deal because they get thier world view from what they see on screen.


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## medicsb (Mar 4, 2012)

As usual, others are so quick to assume that another medical professional did something wrong... So quick to throw another under the bus... based on another poorly written news article.  No one will ever learn, it seems. 

Based on this, which I'd trust a little more than NBC, they did a fine job:
http://www.med.navy.mil/sites/nmcsd/Pages/News/news-20120229.aspx


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## WTEngel (Mar 4, 2012)

CAB for healthcare providers does not mean that breaths are withheld and not administered.

It simply means that we give breaths after an initial round of 30 compressions. They still teach opening the airway, administering breaths, and using various simple airway adjuncts in the health care provider course. 

The fact that people here think the transition from ABC to CAB means we remove breaths all together is very disappointing. At most we are looking at a delay of 18 seconds from the previous algorithm of when breaths should be administered.

Breaths for lay rescuers and friends and family were removed because they were not being done properly most of the time, and presented a barrier to people in that category performing compressions all together.

ABC v. CAB had nothing to do with the difficulty they had during resuscitation in this case, as far as I can tell. Admittedly the article is poorly written, and most likely has the traditional omission of 80% of the critical information, but of well...


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## Veneficus (Mar 4, 2012)

medicsb said:


> Based on this, which I'd trust a little more than NBC, they did a fine job:



I don't.

The physicians may have done a fine job in this instance. 

I wasn't there so I will not judge.

But I have dealt with Navy medicine first hand, and I have nothing good to say about it, or the officers that masquerade as doctors.


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## Aidey (Mar 4, 2012)

That information makes it even worse! It was an anesthesiologist that was bagging the patient!?! And the Navy MDs were Ear, Nose and Throat residents?! I'm sorry, but I literally LOLd. Props to them for saving the guy, but its still amusing as heck. 

And WT, I know they didn't take A and B out completely. The title was meant as a humorous jibe at the fact that everyone is making a simple jaw thrust and OPA sound like something House would come up with at the last second to save the day


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## medicsb (Mar 4, 2012)

I don't see how it's any worse or how you're any less of a Monday-morning-quaterback.  

It's clear they did not neglect the "A".  I'm willing to bet the patient was being  ventilated by the anesthesiologist.  In all reality, the placement of the OPA and the pt. response was likely coincidental. 

It's obvious that this is all PR and, sure, the resuscitation may have been performed better or worse than reported.  But, I don't really care.  There is someone who is alive (hopefully he didn't die since) as a result of these two docs and an unnamed anesthesiologist and an unnamed nurse.  Good for them; on to the next story.

I just don't get why you and so many others automatically assume the worst of someone else who works in the same general profession as yourself?  Maybe it makes you feel like more of a medic?  I just don't get why people in healthcare/medicine are so quick to cut each other down.  It's silly, really.


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## firetender (Mar 4, 2012)

medicsb said:


> I just don't get why people in healthcare/medicine are so quick to cut each other down. It's silly, really.


 
I would suspect it's present in most high-pressure jobs at about the same proportion as it is here.

My guess is it's all within the normal band from low self-esteem to super-inflated ego.


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## mycrofft (Mar 5, 2012)

The newsies always get it at least partly wrong


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## STXmedic (Mar 5, 2012)

mycrofft said:


> The newsies always get it at least partly wrong



Amen! Had an MV-Structure a few shifts back with only one patient that was sable with mild injuries. That night on the news: two patients critically injured and flown out. Wtf??


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