# New CPR protocols



## CodeSurfer (Jan 17, 2007)

I was at my fire department tonight for a CPR refresher course.  I have had the new CPR before, sometime in November 2006, but came upon a discepency tonight.  The instructor said that we are no longer to check for a pulse before beginning CPR or at anytime during CPR or AED use.  I have been an EMT for 2 years and there is no way that I can feel comfortable doing CPR without making sure there is no pulse, let alone attatching an AED!  So I said "surely you can check a pulse if you are an EMT and feel more comfortable doing so", and they told me that I cant!!!!!  The instructor even said that I could be sued and lose my license for checking pulse because that delays care to the patient.  I can understand that bystanders can make mistakes and take a long time looking for a pulse therefore it may be more suitable to bypass that step in their case, but as a medical professional?  I cannot feel comfortable going up to an unconscious patient, shaking them, doing a sternal rub or trap pinch and when they dont respond doing CPR... it's just not right!


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## Ridryder911 (Jan 17, 2007)

You can tell the instructor from me that they are F.O.S. (if they don't what that means, then have them look it up) There is no way of anyone going to get sued for checking a pulse!.. For one thing monitors cannot detect pulse only electrical activity.. 

Do what it takes to get per say re-cert but checking a pulse will not get you sued and actually may reduce your chance of litigation. 

Your instructor of course is teaching according to standards, but to make an asinine statement like that is ridiculous and displays their ignorance. Obviously, this person just demonstrated they have no real life experience or common sense.

R/r 911


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## MMiz (Jan 17, 2007)

I agree with Rid.  The new protocols were dumbed down to make CPR accessible to everyone.  While some protocols actually help improve the chances of successful codes for health care professionals, many steps are for the layperson.


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## oldschoolmedic (Jan 17, 2007)

Let me give you an example of how dogamtic and inflexible the AHA is about their cert classes. I taught AHA CPR for eight years, both for the local AHEC and in the community on my own. I never had a problem with them until I made a typo submitting my class rosters, I hit the wrong last number in the  date for the expiration making the card valid for two years by accident. The cards were processed and mailed. I then received a rather nastily worded letter telling me because of said typo I now had to attend an instructor refresher class and be monitored for a year by three other instructor trainers. Also I was no longer allowed to be the lead instructor until I passed this probationary period. I politely told them that as far as I was concerned they could stick their probationary period intheir taint and walk a mile for a simple typo. All I should have had to do to rectify this would be issue a correctly dated card. Instead I was going to have to rework my whole life to teach at their convenience, because they would now be able to require me to teach certain classes they set up within the AHEC. I no longer advocate for them, but as much as it galls me I have to maintain my certs in BLS, ACLS, and PALS through them.


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## Airwaygoddess (Jan 17, 2007)

MMiz said:


> I agree with Rid.  The new protocols were dumbed down to make CPR accessible to everyone.  While some protocols actually help improve the chances of successful codes for health care professionals, many steps are for the layperson.


I also agree with you both, but you know what will happen.  AHA will conduct another big study, change the guidelines once again.  But the really big question is.... with all of the thousands of AEDs that are out there, will these AEDs ever be re-programed to the new shock protocols that AHA has "required"?  The little voice in my head tells me 'fairly slim chance of that":wacko:


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## KEVD18 (Jan 17, 2007)

horsechit!!!! healthcare providers check pulses. lay people dont. end of story. and as far as being so apprehensive about attatching the aed without a pulse check, remember that the aed cant shock anything but vf and vt. if theyre not in those rythyms, it wont even charge, much less shock.


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## Ridryder911 (Jan 17, 2007)

As an AHA Instructor for the past 28 yrs on all levels (BLS, ACLS, PALS, NRP) etc.. I have seen nothing but a downward trend and disappointment in their modifications and delivery of teaching and qualifying or evaluating students of their course. 

There are many that feel the same as I do and as well no longer hold the same respect and regards of the AHA standards and programs as once was held. It is a shame some other organization will not adsorb the emergency cardiac care and make sure quality standards, educational programs, and testing and certification that AHA once performed. 

When I see an AHA card any more, it means nothing to me. Once I would acknowledge that this person at least met standards and understanding to provide emergency care, now it only means they sat in a classroom for a day or two, and watched some videos. 

I recognize the need of different educational deliveries, but to water down the standards and basically no proper evaluation or testing criteria occurs that displays validity. 

Yes, I teach and to the their standards, because it is my job and that is what is required, until something better is developed. 

R/r 911


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## CodeSurfer (Jan 17, 2007)

KEVD18 said:


> horsechit!!!! healthcare providers check pulses. lay people dont. end of story. and as far as being so apprehensive about attatching the aed without a pulse check, remember that the aed cant shock anything but vf and vt. if theyre not in those rythyms, it wont even charge, much less shock.



I actually have a strip I saved from a patient in v.fib who was alert and talking to me... would the AED shock him? Dont know, I didnt care to try it.


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## fm_emt (Jan 17, 2007)

Ridryder911 said:


> When I see an AHA card any more, it means nothing to me. Once I would acknowledge that this person at least met standards and understanding to provide emergency care, now it only means they sat in a classroom for a day or two, and watched some videos.



I felt really rushed through my recent AHA class, to be honest with ya. I think that I might go back and re-take the current Red Cross class just for a refresher.
At the very least, my chapter gets a few bucks.


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## hoosierdaddy (Jan 17, 2007)

Oooooh.  You guys touched on my biggest irritation--AHA.

I have to agree about the amount of garbage that the AHA puts out.  I've thought for years that sometimes they change their protocols simply to sell new books.  The part that really irritates me is the "2 minutes of CPR before a shock" garbage.  CPR does not fix the VF.  Electricity fixes the VF.  It's that simple.

Don't even get me started about ACLS...


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## firecoins (Jan 17, 2007)

check the pulse!


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## Ridryder911 (Jan 17, 2007)

hoosierdaddy said:


> Oooooh.  You guys touched on my biggest irritation--AHA.
> 
> I have to agree about the amount of garbage that the AHA puts out.  I've thought for years that sometimes they change their protocols simply to sell new books.  The part that really irritates me is the "2 minutes of CPR before a shock" garbage.  CPR does not fix the VF.  Electricity fixes the VF.  It's that simple.
> 
> Don't even get me started about ACLS...



Actually, many of us know CPR will cause fine V-fib to go to course v-fib therefore a shockable rhythm. If one has fine v-fib, chances of fib to aystole is great. Personally, they should never taught immediate defib.. unless the monitor detected very course fib. to begin with.

For as the patient conscious, alert, talking .. I would check my monitor again. I am sure they did not do it very long...

R/r 911


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## wolfwyndd (Jan 18, 2007)

Yeah, I'm not a big fan of AHA's CPR courses either.  I prefer the Red Cross' version much better, unfortunatly, as has already been stated, to keep my EMT-B, I have to take the AHA rather then the Red Cross' version.


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## FF/EMT Sam (Jan 18, 2007)

CodeSurfer said:


> I was at my fire department tonight for a CPR refresher course.  I have had the new CPR before, sometime in November 2006, but came upon a discepency tonight.  The instructor said that we are no longer to check for a pulse before beginning CPR or at anytime during CPR or AED use.  I have been an EMT for 2 years and there is no way that I can feel comfortable doing CPR without making sure there is no pulse, let alone attatching an AED!  So I said "surely you can check a pulse if you are an EMT and feel more comfortable doing so", and they told me that I cant!!!!!  The instructor even said that I could be sued and lose my license for checking pulse because that delays care to the patient.  I can understand that bystanders can make mistakes and take a long time looking for a pulse therefore it may be more suitable to bypass that step in their case, but as a medical professional?  I cannot feel comfortable going up to an unconscious patient, shaking them, doing a sternal rub or trap pinch and when they dont respond doing CPR... it's just not right!



Walk up to your instructor, and punch him in the face repeatedly.  When he falls to the ground, DO NOT check for a pulse, but begin CPR.  Bonus points if you can find a way to shock him, too.


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## hoosierdaddy (Jan 18, 2007)

Sorry I forgot the initial point of the thread.  Yup, check the pulse first.  The guy obviously misspoke (or worse).

As I said earlier though, I'm a big, big, big believer in a shock ASAP.  I've done it in EP labs for years, and it's the primary idea behind ICDs--you can get the vast, vast majority of the population out of VF within the first 20 seconds (I know--not very realistic in the field).  Time is everything with VF.

I just don't know what the AHA thinks sometimes.


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## emttiv (Jan 20, 2007)

You can agree or disagree with the AHA, but the fact is certain that your instructor is frightening. The newest AHA guidelines are available for anyone to read and should certainly be read by those teaching CPR based on the AHA.  

For the record. You can sue someone for ANYTHING. Getting it to stick is trick. 

Yes: check for a pulse. Don't: take more than 10 seconds.


EMTTIV
http://www.emt-national-training.com
We recently added 80 new BLS AHA CPR and AED questions to our database of 2300 questions


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## CodeSurfer (Jan 22, 2007)

Ridryder911 said:


> Actually, many of us know CPR will cause fine V-fib to go to course v-fib therefore a shockable rhythm. If one has fine v-fib, chances of fib to aystole is great. Personally, they should never taught immediate defib.. unless the monitor detected very course fib. to begin with.
> 
> For as the patient conscious, alert, talking .. I would check my monitor again. I am sure they did not do it very long...
> 
> R/r 911



The monitor was accurate... and yes, he didnt have a chance to say much.  He sat upright and talked for about 2-3 minutes, almost 2 minutes of that were spent in v.fib.


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