# CPR Board



## PeteBlair (Apr 28, 2008)

My textbook talks about a CPR board but does not answer all of my questions.  Can this device be used to provide enough support so that it can be used on a standard mattress, or must the patient be placed on a hard surface such as a floor?


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## rmellish (Apr 28, 2008)

If we're talking about the same thing, then the CPR board is designed to be placed under a patient to enable compressions on a hospital bed or ambulance cot.


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## PeteBlair (Apr 28, 2008)

OK, but how about a bed at the patient's home?


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## rmellish (Apr 28, 2008)

Dependent on the situation, protocols, etc, I'd put them on a longboard. From there they can go to the cot if its a load and go, or to the floor if you work the code on scene. 

The benefit of the long board is that it becomes much easier to move the patient, while still providing a hard surface. The CPR board provides the surface, but also does not support the rest of the patient's body. 

Every code I've seen prehospital involved the patient being placed on a longboard PTA by first responders on scene. 

I know some EMS services used to keep a short spine board (different than a CPR board) under the mattress at the head of the cot for CPR, but I'm not sure we even carry short boards on all of our trucks anymore.


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## skyemt (Apr 28, 2008)

same here...

pt gets put on an LSB...

there is no way to do effective compressions on anything other than a hard surface, and the LSB provides the easiest way to transfer the pt from home to rig to hospital, if they're fortunate to get that far...


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## PeteBlair (Apr 28, 2008)

Let's see if I understand what you are saying...  A reasonable thing to do when faced with a CPR situation, where the patient is at home in bed, is to log roll them, in the bed, on to a LSB (again, on the bed) and begin the chest compressions.  Is that what you (sky... and rm...) are saying?


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## skyemt (Apr 28, 2008)

they may have already been place on the floor, because you need leverage to do good compressions... but yes, they will end up on the LSB...

keep in mind, you are saying "log roll", but you getting them on the board the fastest way possible, and you are not worried about a proper "roll" onto the board... it's not a spinal precaution thing, it's a "we need to get good compressions now!" thing...

hope that helps.


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## ffemt8978 (Apr 28, 2008)

We have CPR short boards on our rigs.  Basically, they're old wooden backboards that were cut in half to give us something to work with.  I've used it twice, both times for patient's that coded in the back of the rig.


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## mikie (Apr 28, 2008)

skyemt said:


> pt gets put on an LSB...



Head blocks obviously, but do you put a collar on them?


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## PeteBlair (Apr 28, 2008)

Why head blocks?


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## mikie (Apr 28, 2008)

PeteBlair said:


> Why head blocks?



Well maybe I am wrong, but keeping their head-in-line keeping a patent airway after it has been secured (advanced airway or simple (depending on your service)

Am I wrong?


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## rmellish (Apr 28, 2008)

Last code I ran, pt was not placed in c-spine precautions, just on the longboard.  

I haven't really heard of using blocks and collars simply b/c its a code.


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## mikie (Apr 28, 2008)

rmellish said:


> I haven't really heard of using blocks and collars simply b/c its a code.



I figured a collar wasn't used (unless a significant MOI warrents it), could make achieving a patent airway difficult.  

Thanks for letting me know.  I can never learn enough!


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## rmellish (Apr 28, 2008)

Ideally, there would be an ET tube, which, if secured and placed properly, would be a patent airway.


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## PeteBlair (Apr 28, 2008)

We use the Comb-Tube.  The lab instructor in our course says to use the OPA until you get into the truck and then switch to the Combi.  I've heard other say go for the Combi ASAP.  Which do you do?


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## firecoins (Apr 28, 2008)

PeteBlair said:


> OK, but how about a bed at the patient's home?



you use a backboard


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## rmellish (Apr 28, 2008)

PeteBlair said:


> We use the Comb-Tube.  The lab instructor in our course says to use the OPA until you get into the truck and then switch to the Combi.  I've heard other say go for the Combi ASAP.  Which do you do?



I'm not a PI or an expert by any means, but the combi has several benefits over the OPA. 

1. can prevent aspiration
2. provides a better patent airway
3. Easier to ventilate pt.


Neither would be used if a pt. has a gag reflex. 

I've never been on a prehospital code where suction was not required. Given the two choices, I think the combi is a much better option for preventing aspiration. Out of hospital arrest survival rates are poor as is. Out of hospital arrest with aspiration is even worse. 

Also, the combi is a direct hookup to the BVM, whereas the BVM mask still needs to be stabilized using an OP airway. It's alot easier to bag a combi than it is an OPA. 

A combi takes less than a minute to place, inflate, check, and use. Given the two, I'd go combi-tube first.


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## MSDeltaFlt (Apr 28, 2008)

For CPR, you don't need anything on the board but the board itself.  If they code on you on your stretcher in the back of the truck, don't need anything at all.  The mattress is hard enough that you can do effective CPR on it without any aids.  The CPR board is, in my humble yet honest opinion, a waste of much needed space on an ambulance if you have a LSB within easy reach.


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## MSDeltaFlt (Apr 28, 2008)

rmellish said:


> I'm not a PI or an expert by any means, but the combi has several benefits over the OPA.
> 
> 1. can prevent aspiration
> 2. provides a better patent airway
> ...



Check off sheets say to use OPA first then go to Combi.  It doesn't mention where, but it is "assumed" right then and right there.  Don't move the pt first.  If you did, I'd flunk you... right then right there.


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## rmellish (Apr 28, 2008)

So at a code, with CPR started, at a BLS level, try the OPA first? 

Assuming no gag reflex.


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## CFRBryan347768 (Apr 28, 2008)

rmellish said:


> So at a code, with CPR started, at a BLS level, try the OPA first?
> 
> Assuming no gag reflex.



And no head injury. I'd go for that first.


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## skyemt (Apr 28, 2008)

for whatever it's worth, 
if you guys are running a code, the pt is effectively dead unless you can get ROSC.

what is the point of focusing on head chocks, and potential head injuries? or even airways right off the bat?

there's a head injury alright, the brain isn't getting oxygen because he's DEAD! LOL...

the whole point of the early code is to get effective AED usage (if within the first 4-5 minutes), or to do effective, quality CPR if arrest unwitnessed. yes, ACLS meds will be urgent, as will the advanced airway, but it is not what's done first. even ACLS is based on good quality CPR.

the point of the LSB (or similar) is that without it, you really can't get effective compressions.  anything soft, that will absorb some of the energy of the compressions, may well render your aid useless.


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## MSDeltaFlt (Apr 28, 2008)

rmellish said:


> So at a code, with CPR started, at a BLS level, try the OPA first?
> 
> Assuming no gag reflex.



If they're dead, they will have no gag reflex.  Do the OPA first then Combi


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## Jeremy89 (Apr 28, 2008)

skyemt said:


> for whatever it's worth,
> if you guys are running a code, the pt is effectively dead unless you can get ROSC.
> 
> what is the point of focusing on head chocks, and potential head injuries? or even airways right off the bat?
> ...



Correct me if I'm wrong, but while doing CPR, aren't you circulating blood and breathing for the pt?  So if that was the case, wouldn't the brain still be getting some O2?


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## skyemt (Apr 28, 2008)

Jeremy89 said:


> Correct me if I'm wrong, but while doing CPR, aren't you circulating blood and breathing for the pt?  So if that was the case, wouldn't the brain still be getting some O2?



yes... my point, though, is that when you come upon the arrest, it is getting nothing, there is nothing circulating, and acid building up.

it is a matter of priorities... studies have shown that the percentages are poor anyway for ROSC, but the best chance is to do immediate quality CPR (unless witnesses arrest, then AED), and you need to be on a hard surface...

the other stuff will not mean anything, if the process is not started correctly.

hope that clears things up a bit...


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## MAC4NH (Apr 28, 2008)

Instead of a long board we usually use a reeve's stretcher.  The slats give you enough support to do compressions and it's much faster and easier to get the patient down stairs, especially in old multiunit houses with narrow staircases.


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## Ridryder911 (Apr 28, 2008)

Here is the traditional CPR board, with the head "scooped" out to allow the head to stay in a head tilt position, as well as a firm surface. They have been out for a couple of decades or more. True most use a LSB or anything firm, so compressions can be effective. 







Head blocks or even C-collars is not unusual on arrest (for ALS) to help reduce "pulling or dislodging" the tube. 

R/r 911


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## Jon (Apr 28, 2008)

Ridryder911 said:


> Here is the traditional CPR board, with the head "scooped" out to allow the head to stay in a head tilt position, as well as a firm surface. They have been out for a couple of decades or more. True most use a LSB or anything firm, so compressions can be effective.
> 
> 
> 
> ...


You will sometimes see those boards on rigs... but they are more often found in the supply cabinets because they looked like a good idea, but really aren't.

In the hospitals, I've often seen a 2ftx3ft piece of Plexiglas or thick plastic attached to the side of the hospital's code carts... this works great as a CPR support on a hospital bed.


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## ErinCooley (Apr 29, 2008)

PeteBlair said:


> We use the Comb-Tube.  The lab instructor in our course says to use the OPA until you get into the truck and then switch to the Combi.  I've heard other say go for the Combi ASAP.  Which do you do?



EMT-I combitube station on the NR practical not using a OPA/NPA is failing criteria.  You preoxygenate the pt with NRB while the adjunct is in place then remove it to insert the tube.


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## Ridryder911 (Apr 29, 2008)

ErinCooley said:


> EMT-I combitube station on the NR practical not using a OPA/NPA is failing criteria.  You preoxygenate the pt with NRB while the adjunct is in place then remove it to insert the tube.



The usual standard to pre-oxygenate the patient for upto three minutes prior to insertion of any Adavanced Airway Device. 

R/r 911


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## Airwaygoddess (Apr 29, 2008)

*Back boards!*

Can't tell you how many times we would get a call for seizures, and they wound up being Code Blues......Long back boards are a great thing!  By the way, Santa Barbara's protocol for advanced airway requires c-collar and head beds being placed on the patient, this helps with not losing ET tube placement.


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## PeteBlair (Apr 29, 2008)

Head Bed is a new term for me.  What is that?  Would that also be known as "head blocks?"


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## Airwaygoddess (Apr 29, 2008)

*head beds!*

pre made, although not my favorite,

www.boundtree.com

Give me a roll of 2 inch cloth tape and "cheese blocks" you will not move!! ^_^


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## BossyCow (Apr 29, 2008)

I've used the CPR board once and just for that little scoop out for the head. It maintained an airway on rough terrain where it was difficult to get good access to the pt. The board stabilized them nicely. 

As for the combi-tube, in practice, the OPA is used until the Combi-tube is ready for insertion. As protocol states the tube is to be lubricated, and both balloons tested prior to insertion, there's time passing with no airway adjunct in place.


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## Katie (Apr 29, 2008)

PeteBlair said:


> Head Bed is a new term for me.  What is that?  Would that also be known as "head blocks?"



yeah pretty much.  here's one example.


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## mikeylikesit (Jun 4, 2008)

yeah the lsb is good and all until they code on the cot in the back of the Ambo. are you gonna pull over to get out the LSB? i use the CPR when ever there is one in an AMBO period unless they are already on a LSB.


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## Grady_emt (Jun 4, 2008)

Our protocol states that any code goes on a LBB, and that the pt have a C-collar placed to help maintain a patent airway.  The head doesnt have to be "blocked" in place as would be the case for a trauma call.  Also, only one strap is "required", but usually ill go ahead and use two just to make sure they dont slide off.


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## emt357085 (Jun 4, 2008)

why bother with a short board  just use a long board so u could also transport on it


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## mikeylikesit (Jun 4, 2008)

you know those CPR boards double as a nice snack tray in the back of the AMBO. i think mine gets the most use during lunch.^_^J/K


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## AnthonyM83 (Jun 8, 2008)

emt357085 said:


> why bother with a short board  just use a long board so u could also transport on it


I'd never bring a short board on a cardiac arrest call. It's not going to help carry them out if you're transporting nor help keep airway secure when transferring to the gurney nor help in smooth transition from gurney to ER bed. 

Short board is pretty much for patients who code during transport (yet most around here don't keep it at easy access) or maybe for pediatric spinal immobilization. I heard before they days of the KED, they used to be used for extrication.


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## MAC4NH (Jun 8, 2008)

AnthonyM83 said:


> Short board is pretty much for patients who code during transport (yet most around here don't keep it at easy access) or maybe for pediatric spinal immobilization. I heard before they days of the KED, they used to be used for extrication.



We carry a short board on my volly unit but not on the paid one.  In the paleolithic days, we used them just like a KED.  You put the board behind the patient in the car and secured them to it with cravats.  Then you got them onto a long board just like with the KED.  As annoying as the KED can be, it is faster than the short board.  When I learned short board in an advanced first aid course in 1983, we saw a slide presentation about that wonderful new invention called the KED.  And we drooled.  BTW, in that slide presentation it showed a patient being raised out of a car (-roof) with a winch.  I don't think that's included in the modern KED instruction book.


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## CFRBryan347768 (Jun 8, 2008)

firecoins said:


> you use a backboard



I have a silly question, why not pull them on the floor? Its not like that takes a long time?


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## ffemt8978 (Jun 8, 2008)

CFRBryan347768 said:


> I have a silly question, why not pull them on the floor? Its not like that takes a long time?



Because then you've got to pick them back up to put them on the stretcher.  Not always the easiest of things to do.


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## AnthonyM83 (Jun 8, 2008)

CFRBryan347768 said:


> I have a silly question, why not pull them on the floor? Its not like that takes a long time?



Found on bed, get them on the floor right away.

But if you transport, you'll need long board (to transfer to gurney, place equipment on, transfer to ER bed, flat surface for compressions en-route or if re-codes or intubation)

Short board only useful when you can't slide long board in...ex: during transport.

So, if you have the long board, don't use short board, because it has the benefits of short board, plus more.

There.
(except maybe an infant arrest, etc...something like that)


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