# CPR and AED



## EMTBWannabe (Mar 8, 2010)

I have read, re-read, and re-re-re-read the "pro" edition of the American Heart Association CPR and AED manual.

I am a EMT-B student with 2 weeks under his belt and will be tested on CPR both written and practical.

I am confused as to when to use the AED (of course provided that I have determined that an AED should be used).

so here's the question:  

for Adults - (unwitnessed conscious) i will call 911 and try to get an AED first and then start cpr - before i start CPR i will open the air way using the head tilt chin lift and look, listen, feel for breathing- using no more than 10 secs.  then i check his carotid artery to see if he has a pulse.  if there is no pulse - i should do 5 cycles of CPR and then hook up the AED for analysis and possible shock.  IS THIS CORRECT?


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## EMTBWannabe (Mar 8, 2010)

sorry i hit the wrong button and didnt' finish my question.


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## EMTBWannabe (Mar 8, 2010)

here's my email in full:

I have read, re-read, and re-re-re-read the "pro" edition of the American Heart Association CPR and AED manual.

I am a EMT-B student with 2 weeks under his belt and will be tested on CPR both written and practical.

I am confused as to when to use the AED (of course provided that I have determined that an AED should be used).

so here's the question: 

for Adults - (unwitnessed conscious) i will call 911 and try to get an AED first and then start cpr - before i start CPR i will open the air way using the head tilt chin lift and look, listen, feel for breathing- using no more than 10 secs. then i check his carotid artery to see if he has a pulse. if there is no pulse - i should do 5 cycles of CPR and then hook up the AED for analysis and possible shock. IS THIS CORRECT? 

for adults (witnessed) i will call 911 and get an AED... i will do assessment of breathing and pulse.  if there is no pulse or breathing do i go straight to the AED without giving CPR?

for pediatric pts - (unwitnessed) give 5 cycles of cpr... then call 911 and get AED - hook up AED for analysis and shock (if advised)... and resume cpr... is this right?

for pediatric pts - witnessed - call 911 and get AED.  do i give 5 cycles of CPR before i hook up the AED? or go straight to the AED for analysis and possible shock... and then perform another 5 cycles of CPR?

please advise.

thanks
m


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## NepoZnati (Mar 8, 2010)

I managed to get 100% on that test so I should know this... I have to run on my class but I tried to type short answer. Hope this helps: 

1) Adults: Call for ALS after establishing unresponsiveness and *BEFORE you begin CPR*. 

*establish unresponsiveness – call 911 if no response – position Pt – open airway – look, listen & feel for no more than 10 sec. – DELIVER 2 BREATHS – CHECK CAROTID (5-10 sec.) – if no pulse START the CPR*

Kids:  Call for ALS after establishing unresponsiveness and *AFTER 2 minutes of CPR*.

2) *BEFORE you start with AED* you should administer 5 cycles of CPR (2 min.) prior to first shock (that is to "re-prime the pump") 

3) If you coming on the scene with the AED and someone else is already doing the CPR, stop them and apply the AED. 

4) You *do NOT stop CPR on your patient to go look for AED* but rather dedicate someone to go and bring it to you... CPR should start right away after initial assessment. 

5) Once the AED came on the scene all CPR stops and AED is applied.


Good luck to you.


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## EMTBWannabe (Mar 8, 2010)

thanks.

sounds like the only difference is - when to call ALS (or 911) - i think we're doing cpr in a sense that we're bystanders.  

call 911/ALS for adults immediately then CPR

for Kids start CPR for 5 cycles and then call 911/ALS.

m


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## medichopeful (Mar 8, 2010)

Basically, unless I'm mistaken (which I shouldn't be h34r, for ANY unwitnessed arrest (without CPR in progress), begin with 5 cycles of CPR (to get "new" blood to the body and to perfuse the organs (blood without wastes, lactic acid, etc.).

For unwitnessed arrests with CPR in progress, if it's good CPR, then ask how long it's been going on.  If longer than 2 minutes (or if started immediately after arrest), go straight to the AED.  If not, begin CPR.

For any witnessed arrest, go straight to AED.


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## CA_EMT (Mar 9, 2010)

medichopeful said:


> Basically, unless I'm mistaken (which I shouldn't be h34r, for ANY unwitnessed arrest (without CPR in progress), begin with 5 cycles of CPR (to get "new" blood to the body and to perfuse the organs (blood without wastes, lactic acid, etc.).
> 
> For unwitnessed arrests with CPR in progress, if it's good CPR, then ask how long it's been going on.  If longer than 2 minutes (or if started immediately after arrest), go straight to the AED.  If not, begin CPR.
> 
> For any witnessed arrest, go straight to AED.



This is correct. We just covered this in class on Saturday. Performing 5 cycles of CPR increases the chances that the AED can knock out V-Fib on the first shock.


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## zmedic (Mar 9, 2010)

CA EMT; said:
			
		

> This is correct. We just covered this in class on Saturday. Performing 5 cycles of CPR increases the chances that the AED can knock out V-Fib on the first shock.



That's true, but my understanding was that in the last update AHA said that it was up to each medical director if they want to to have 2 minutes of CPR before AED is used, though it is recommended. Also note that this applies to people who have been down for more than 4 minutes before the AED is on scene. If you are in the back of your ambulance, the patient is talking to you and passes out, you check and there is no pulse or breathing you give 2 breaths and then hook up the AED. 

You don't need the 2 minutes of CPR because the patent just went down, the heart is full of oxygenated blood, and they have to have their electrical problem fixed.


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## EMTBWannabe (Mar 9, 2010)

i just passed my cpr exam... it was alot easier than i thought and i remembered alot of the skills taught.

i scored 100% on the written but i felt it was too easy.

thanks for all your thoughts.


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## EMTBWannabe (Mar 9, 2010)

NepoZnati said:


> I managed to get 100% on that test so I should know this... I have to run on my class but I tried to type short answer. Hope this helps:
> 
> 1) Adults: Call for ALS after establishing unresponsiveness and *BEFORE you begin CPR*.
> 
> ...



i see you are in NYC - where do you train?


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## NepoZnati (Mar 9, 2010)

EMTBWannabe said:


> i see you are in NYC - where do you train?


Hi,

I am in one small school in the Bronx... I am almost done. In two days I am taking my finals and then next week my state exams... Kudos on the 100% score! It was easy and yet some in my class needed to take it 3 times!? And he is also passing the school even that he doesn't know what BLS means... Go figure.


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## EMTBWannabe (Mar 9, 2010)

NepoZnati said:


> Hi,
> 
> I am in one small school in the Bronx... I am almost done. In two days I am taking my finals and then next week my state exams... Kudos on the 100% score! It was easy and yet some in my class needed to take it 3 times!? And he is also passing the school even that he doesn't know what BLS means... Go figure.



I think that is scary.


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## EMTBWannabe (Mar 10, 2010)

NepoZnati said:


> Hi,
> 
> I am in one small school in the Bronx... I am almost done. In two days I am taking my finals and then next week my state exams... Kudos on the 100% score! It was easy and yet some in my class needed to take it 3 times!? And he is also passing the school even that he doesn't know what BLS means... Go figure.



good luck with your finals and exams!  pls let me know the outcome.


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## EMTBWannabe (Mar 10, 2010)

NepoZnati said:


> Hi,
> 
> I am in one small school in the Bronx... I am almost done. In two days I am taking my finals and then next week my state exams... Kudos on the 100% score! It was easy and yet some in my class needed to take it 3 times!? And he is also passing the school even that he doesn't know what BLS means... Go figure.



any advice on which stethoscope and blood pressure cuff to get?


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## thatJeffguy (Mar 10, 2010)

If you check out www.emtb.com you'll find the review guides are the same checklists that the national registry uses.  I print those and use them as a guideline.

Other than that, "what everyone else said"


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## NepoZnati (Mar 10, 2010)

EMTBWannabe said:


> good luck with your finals and exams!  pls let me know the outcome.


Thank you.  Hopefully I would have some good news by the end of the next week. 


EMTBWannabe said:


> any advice on which stethoscope and blood pressure cuff to get?


That I do not know. I am sorry. My course is paid by the some organization and books and equipment I got in the package. Therefore, I did not needed to search for them... If you search here you will find posts that they taking about equipment and many more advices. Example: 

http://www.emtlife.com/showthread.php?t=6096&highlight=stethoscope

http://www.emtlife.com/showthread.php?t=14626&highlight=stethoscope


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## EMS84 (Mar 21, 2010)

after you deliver a shock,remember to stay consistent with cpr. if you go checking for a pulse after words,you will fail. just a tip. time is crucial.



cheers.


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## NepoZnati (Mar 21, 2010)

EMTBWannabe said:


> good luck with your finals and exams!  pls let me know the outcome.


I passed last Thursday... I am now NY State certified EMT. Be warned!


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## Martyn (Mar 21, 2010)

Glad I live in Florida...seriously though, congrats.


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## MrBrown (Mar 21, 2010)

The book you are using is for lay rescuer wheresas Ambulance Officers should be using something slightly different because of the higher level of care that can provided.

For example; adult witnessed arrest is taught do two minutes of CPR then call the ambo's and hook up the AED.  If I am approaching a cardiac arrest as a lay person while I am out-and-about spending my hard earned money in pursuit of the capalist dream that's pretty much what I'd do, however, as an ambo you look to shock first if it's a witnessed arrest.  

Not much point doing CPR for two minutes on somebody who just fell down when you have a monitor/defibrillator right there with you.  What is the only proven effective treatment for VF or VT, CPR or defibrillation?

Paediatric patients most likely have an airway obstruction or a seizure or some other non-cardiac cause for thier being unconscious.


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## NepoZnati (Mar 21, 2010)

Or, as I was told, if witnessed arrest one can use a precordial (fist) thump on adults.


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## MrBrown (Mar 21, 2010)

NepoZnati said:


> Or, as I was told, if witnessed arrest one can use a precordial (fist) thump on adults.



I don't know of anywhere that still advocates the precordial thump.

Then again, I was told of a job where somebody kept flip flopping between VF and sinus rhythm so the Officer I was speaking with just "kept smashing him in the chest and he reverted back...."


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## NepoZnati (Mar 21, 2010)

MrBrown said:


> I don't know of anywhere that still advocates the precordial thump.


That's what I was told... But ONLY if witnessed and only once.


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## mycrofft (Mar 21, 2010)

*Learn your protocols and use them. (cough cough)*

Her I go gassing off again, but having seen CPR being "perfected" for nearly five decades:
1. Virtually no one survives CPR without quick intervention at least at the AED level. That is, unless the pt really didn't need CPR, or the cause was an electric shock. Instead of trying to get your compressions right on the desired speed, you should be screaming for backup. Even with AED, everyone who gets CPR, rescue breathing or airway clearance ought to be assessed and treated at a higher level of care than an ambulance, school nurse, or nursing home.
2. The precordial thump will never be clinically proven. It may very well work, but there is no way to collect data. I figure I can give her/him a thump as I'm leaving to go find the AED or phone or bystanders, as long as I don't curse at them.
3. The days of doing CPR for prolonged periods is over. (personal record: 49 min, pt of course dead). I could DO it for over 3/4 hr because compressions were 60/min; I recently tried the faster and pauseless style and it will whip your behind in much shorter order.


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## NepoZnati (Mar 21, 2010)

I guess I needed to put there that my instructor did say that fib is something that is not commonly done, it is something we maybe can do when no one is looking and it is not approved by protocol. 

By bad, *mycrofft*. You are 100% right. :blush:


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## Owenscott (Apr 4, 2010)

As was mostly said above if unwitnessed cardiac arrest do CPR first and the reason was explained to me ... we want to prime the pump ... IE we want blood in there before the shock so if the shock works there is something to pump.

 I just couldn't keep this all straight until it was explained this way to me. I hope i have helped somebody here ...


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## rescue99 (Apr 4, 2010)

NepoZnati said:


> Or, as I was told, if witnessed arrest one can use a precordial (fist) thump on adults.



Not in a BLS setting.....

I was the lucky one on the receiving end of a thump years ago. It worked but boy, what a thing to do to someone!


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## Owenscott (Apr 4, 2010)

I met somebody that claims to have save TWO ppl with the *thump* for a vol BLS small town ambo thats a lot. She does have years on and nursing homes in her area. I don't believe it is taught any more but specifically not allowed ?? check your protocols.


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## NepoZnati (Apr 4, 2010)

rescue99 said:


> Not in a BLS setting.....



Well, I never said it is by the protocol and it is something "when no one is looking"... But, that's what I was told on my EMT, BLS class. By the NYFD EMT, BLS guys.


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