# Basic CPR Question



## Little-red (Feb 24, 2011)

Hi,
I'm new here and I have a very basic (maybe stupid) CPR question:

Does it matter which side of the patient's body you do CPR compressions from? The illustrations always show it being done on the patient's left side, closer to the patient's heart. I'm assuming sometimes you don't have a choice which side, but is the left vastly superior to the patient's right side? Does it really matter?

Thanks


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## lampnyter (Feb 24, 2011)

Doesnt matter. You always do the compressions between the nipple line though.


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## MasterIntubator (Feb 24, 2011)

Heck...  you can straddle them if you want.  Used to work good in the old days before the 'thumper'.  We would shove up the smallest person on the cot, straddling the pt... so they could do non-stop CPR as we exited the house/entered the ED... etc.  

Yeah.... it lost in favor awhile back...  just a memory these days


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## Little-red (Feb 24, 2011)

Thanks.


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## emt_irl (Feb 24, 2011)

leftside/rightside, overhead its all the same as your compressing the same part of the chest


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## AndyK (Feb 24, 2011)

Little-red said:


> Hi,
> I'm new here and I have a very basic (maybe stupid) CPR question:



The only stupid question is the one you wanted to ask but didn't


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## medicRob (Feb 24, 2011)

MasterIntubator said:


> Heck...  you can straddle them if you want.  Used to work good in the old days before the 'thumper'.  We would shove up the smallest person on the cot, straddling the pt... so they could do non-stop CPR as we exited the house/entered the ED... etc.
> 
> Yeah.... it lost in favor awhile back...  just a memory these days



There have been a couple times where I remember being the one to straddle the patient on the cot as we rolled in to the ER. Those were some good times.


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## Tigger (Feb 25, 2011)

No one in my area has an AutoPulse or equivalent, and riding on the cots is apparently prohibited. What is one to do if you end up transporting a working code during the transfer from the ED bay to room. One handed compressions while walking don't seem too effective.


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## akflightmedic (Feb 25, 2011)

And if you do not like the side you are forced to be on, you can always spin the patient around to make it more comfortable for you....at least that is what 1-2 students do in every single CPR class I have ever taught...


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## Lucy212 (Feb 25, 2011)

There is no such thing as a stupid question if you work in EMS. You ask a question because you want to know or are unsure. If someone thinks it's stupid then ask someone who can help and/or answer you to help you improve your skills and knowledge.

In regards to left/right side compressions; as everyone says you can straddle the patient to perform CPR. The important thing is that the compressions are being performed properly and on the nipple line.

Good luck, you'll do great. Keep asking questions... it's good.

~ L


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## 18G (Feb 25, 2011)

Agree with all the above. Doesnt matter which side you are on. The reality is when out in the field, 9 out of 10 times you won't be given a choice of which side to be on...lol.


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## Little-red (Feb 25, 2011)

Thanks for all the replies - really appreciate it.


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## AtlantaEMT (Mar 14, 2011)

Tigger said:


> One handed compressions while walking don't seem too effective.



They aren't, but I had to do it with a patient going into the ER.  I was on the left side of the stretcher (being I'm right handed) and held on to the right rail with my left arm, put my feet on the bottom stretcher rail, did chest compressions with my right arm, and rode into the ER all the way to the trauma room.  They were quite easy that way.


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## MrBrown (Mar 14, 2011)

Brown wonders if Little Red came to the forum from Grandmas house .....


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## NomadicMedic (Mar 14, 2011)

AtlantaEMT said:


> They aren't, but I had to do it with a patient going into the ER.  I was on the left side of the stretcher (being I'm right handed) and held on to the right rail with my left arm, put my feet on the bottom stretcher rail, did chest compressions with my right arm, and rode into the ER all the way to the trauma room.  They were quite easy that way.



Aka gurney surfing.


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## EMT Dan (Mar 14, 2011)

18G said:


> Agree with all the above. Doesnt matter which side you are on. The reality is when out in the field, 9 out of 10 times you won't be given a choice of which side to be on...lol.




I think that about summarizes it pretty well...



http://emtfiles.blogspot.com/


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## AtlantaEMT (Mar 14, 2011)

n7lxi said:


> Aka gurney surfing.



I guess that is the simple way to put it.  

I did it once in EMT school and some fellow students saw me coming in.  They said it looked cool which is what I like the most about it.


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## Shishkabob (Mar 14, 2011)

AtlantaEMT said:


> They said it looked cool which is what I like the most about it.





Oh boy...


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## usalsfyre (Mar 14, 2011)

AtlantaEMT said:


> They said it looked cool which is what I like the most about it.



Also usually one of the most ineffective ways to do compressions while moving. Usually better to straddle the patient and do them that way if possible. 

However, it doesn't look as cool, and judging from your avatar, I'm sure that's a factor...:glare:


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## abckidsmom (Mar 14, 2011)

usalsfyre said:


> Also usually one of the most ineffective ways to do compressions while moving. Usually better to straddle the patient and do them that way if possible.
> 
> However, it doesn't look as cool, and judging from your avatar, I'm sure that's a factor...:glare:



Looking cool is extremely important...thus the copious threads about boots, pants and stethoscopes.

I like to think that there's actually a point to transporting people with CPR in progress.  If there's a point, then I like to think we're going to do effective CPR during the move.  One handed, cot surfing CPR is totally cool looking, and completely ineffective.


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## AtlantaEMT (Mar 14, 2011)

usalsfyre said:


> Also usually one of the most ineffective ways to do compressions while moving. Usually better to straddle the patient and do them that way if possible.
> 
> However, it doesn't look as cool, and judging from your avatar, I'm sure that's a factor...:glare:



True, but I'm not jumping on some bloody stabbing victim or someone who looks like they eat MRSA for breakfast.  I found it easier to ride the side of a gurney than hop on top of some 300lb fat guy who is already falling off the sides of the stretcher.  But that's just me, you do what you like.


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## usalsfyre (Mar 14, 2011)

AtlantaEMT said:


> True, but I'm not jumping on some bloody stabbing victim


There's not a whole lot of point in doing CPR on someone who's blood volume is laying on the ground, but until medics and/or medical directors realize this I agree, probably best not to make a mess of yourself



AtlantaEMT said:


> or someone who looks like they eat MRSA for breakfast.


Not a whole lot of communicable disease that can be diagnosed on "looking like" something. So what does this mean exactly? Nursing home patients? Homeless patients? Do you not have a spare uniform? What your saying is you provide inferior care based on how the patient looks. 




AtlantaEMT said:


> I found it easier to ride the side of a gurney than hop on top of some 300lb fat guy who is already falling off the sides of the stretcher.  But that's just me, you do what you like.


Easier or impossible? Providing $hitty care because it's easier is called being lazy. I understand this may be impossible on some patients. However, from what it sounded like in your last post you've never TRIED climbing on the gurney, preferring to cot surf because "it looked cool". As far as what I like? I like good care to be provided, convenient and easy for providers not being a major factor in the equation, and "looking cool" not being a factor at all.


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## Chief Complaint (Mar 14, 2011)

Not to thread jack, but ive got a question about CPR as well.

Compressions/ventilations are supposed to be at a ratio of 30:2, and we are also taught that 2 rescuer CPR is done at 15:2.  But ive only witnessed CPR done at a 30:2 ratio, with multiple healthcare providers on scene.  

What am i missing?


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## the_negro_puppy (Mar 14, 2011)

Chief Complaint said:


> Not to thread jack, but ive got a question about CPR as well.
> 
> Compressions/ventilations are supposed to be at a ratio of 30:2, and we are also taught that 2 rescuer CPR is done at 15:2.  But ive only witnessed CPR done at a 30:2 ratio, with multiple healthcare providers on scene.
> 
> What am i missing?



It should be 30:2 now for everything (except neonates) the 15:2 was one of the old ways


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## Chief Complaint (Mar 14, 2011)

the_negro_puppy said:


> It should be 30:2 now for everything (except neonates) the 15:2 was one of the old ways




I guess the guidelines im looking at are old, weird, they were given to us this semester.  They state that its always 30:2 for adults, but 15:2 for pediatrics (excluding neonates) with 2 providers.  Ill be sure to ask in class tomorrow.  Thanks for the reply.


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## mycrofft (Mar 14, 2011)

*Crikey.*

Nipple line on an 86 y/o former stripper? A mastectomy patient? Mid-sternum folks.
CPR fits in a business card: 1/3 the patient's thorax dimension A -> P, eighty times a minute, straight up and down, two breaths per 30 compressions, get help, get an AED, start early, go fast, go deep. 
I'd hate to overturn the ambulance litter with myself and the pt on it.


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## zmedic (Mar 15, 2011)

I'd point out that some stretchers have a 400 lb weight limit. If you have a 250lb patient, 02 tank, monitor etc it isn't really appropriate for you as a 200lb provider to jump on top. Lot of liability if the stretcher collapses.


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## JOgershok (Mar 15, 2011)

akflightmedic said:


> And if you do not like the side you are forced to be on, you can always spin the patient around to make it more comfortable for you....at least that is what 1-2 students do in every single CPR class I have ever taught...



Now that is funny!    How many times have I seen them do it because they were uncomfortable doing it from the left side of the patient or during a switch.  @#$% that I am, I made them do it from both sides.


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## JOgershok (Mar 15, 2011)

zmedic said:


> I'd point out that some stretchers have a 400 lb weight limit. If you have a 250lb patient, 02 tank, monitor etc it isn't really appropriate for you as a 200lb provider to jump on top. Lot of liability if the stretcher collapses.



Who says you have to roll it in the extended position?  They do not tip either.


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## zmedic (Mar 15, 2011)

Wait, do you think the weight limit is only in the extended position? Also, they certainly can tip, especially when you have someone riding on top raising the center of gravity.


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## JOgershok (Mar 15, 2011)

usalsfyre said:


> There's not a whole lot of point in doing CPR on someone who's blood volume is laying on the ground, but until medics and/or medical directors realize this I agree, probably best not to make a mess of yourself



Pennsylvania's BLS Protocols recognise that CPR on an exsanguinated victim is useless:

CARDIAC ARREST – TRAUMATIC
STATEWIDE BLS PROTOCOL

 Criteria:
A. Patient unresponsive, pulseless, and apneic/agonal breaths when acute traumatic injury is the cause of the cardiac arrest.
Exclusion Criteria:
A. If patient meets criteria for DOA (e.g. decapitation, decomposition, rigor mortis in warm environment, etc…) then follow DOA protocol # 322.
B. Patients in cardiac arrest due to overdose, hypothermia, cardiac disease, or other medical conditions when traumatic injuries are not suspected to be the primary reason for cardiac arrest – see Cardiac Arrest protocol # 331.  

http://www.portal.state.pa.us/portal/server.pt/document/713751/pa_bls_protocols_effective_11-01-08_pdf


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## usalsfyre (Mar 15, 2011)

zmedic said:


> I'd point out that some stretchers have a 400 lb weight limit. If you have a 250lb patient, 02 tank, monitor etc it isn't really appropriate for you as a 200lb provider to jump on top. Lot of liability if the stretcher collapses.


Decent point, but I haven't seen a 400lb rated stretcher (other than an ironing board for the aircraft) in a long time. Everything I've seen has been at least 600 in the last 4 years or so. 



zmedic said:


> Wait, do you think the weight limit is only in the extended position? Also, they certainly can tip, especially when you have someone riding on top raising the center of gravity.


Agreed, they certainly can tip. That said MOST of the time if CPR is being performed on the move it's from the ambulance into the hospital (at least here, we try not to put already dead people in the truck), which is generally a smooth, somewhat level surface, and the cot shouldn't be at full height to help offset the elevated center of gravity.


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## usalsfyre (Mar 15, 2011)

JOgershok said:


> Pennsylvania's BLS Protocols recognise that CPR on an exsanguinated victim is useless:
> 
> CARDIAC ARREST &ndash; TRAUMATIC
> STATEWIDE BLS PROTOCOL
> ...



Glad to see someone recognizes it.

There are a few medical directors who don't trust their staff (some of whom have proven they shouldn't be). By and large though the problem is 1.) field providers who "want to give everyone the best chance" and 2.) EMS management who is concerned with how field determination "looks". Neither one is a valid excuse for tying up resources and risking priority transport on patients who realistically have no chance.


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## mycrofft (Mar 15, 2011)

*OOPS 100 a minute!! Sorry!*

Either way, I'm worn out by one minute anyway unless the next defib or abalation works better!

Eeenymeeny chilibeenie, the spirits are about to speak...in twenty years or so, professional CPR for cases other than recent poisoning, drowning or electric shock will be optional if there is no AED available.


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## AtlantaEMT (Mar 16, 2011)

usalsfyre said:


> Easier or impossible? Providing $hitty care because it's easier is called being lazy. I understand this may be impossible on some patients. However, from what it sounded like in your last post you've never TRIED climbing on the gurney, preferring to cot surf because "it looked cool". As far as what I like? I like good care to be provided, convenient and easy for providers not being a major factor in the equation, and "looking cool" not being a factor at all.



Looking cool was more of a joke but for some reason others took it like it is the main reason I cot surf.  I provide the best care possible and is why I've actually had patients call into my work to thank me (even with a paramedic).  I work hard and learn everything I can possible (it's why I'm here).  I'm often up to 3am on the weekends studying as a biochem major so I can go to med-school.  I'm passionate about medicine, to the point I carry a Tabers with me to work and read if I'm not busy with work.  But I feel that cot surfing from the ambulance bay to the trauma bay will be decent enough to sustain the patient until they are transferred to the hospital bed.

I've had more than one medic tell me to get on the side (as I was about to hop on), so I assume it works.  If not then I'd love to see the study or information that shows that one handed chest compressions are inaffective.  Note I said "are inaffective" not "are not as affective".  I don't argue that 2 handed chest compressions are better.


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## usalsfyre (Mar 16, 2011)

AtlantaEMT said:


> Looking cool was more of a joke but for some reason others took it like it is the main reason I cot surf.


I'll give you a pass here.




AtlantaEMT said:


> But I feel that cot surfing from the ambulance bay to the trauma bay will be decent enough to sustain the patient until they are transferred to the hospital bed.


Repeat after me. High quality uninterrupted chest compressions ARE. THE. ONLY. THING. THAT. MATTERS. Full stop, end of message. Not "decent enough" chest compressions. Not "kinda ok" chest compressions. Not "we only stopped for a second to drop a tube" chest compressions. Only "high quality, uninterrupted chest compressions". Anything less is not good enough,



AtlantaEMT said:


> I've had more than one medic tell me to get on the side (as I was about to hop on), so I assume it works.


Never assume just because they're a medic they know what the hell they're talking about.



AtlantaEMT said:


> If not then I'd love to see the study or information that shows that one handed chest compressions are inaffective.  Note I said "are inaffective" not "are not as affective".  I don't argue that 2 handed chest compressions are better.


I can't provide 1 vs 2 hand studies. AHA has a boat full on high quality vs poor quality though. Your not going to convince me one handed CPR on an unstable surface is anything other than poor quality. I've done it a whole bunch, and watched others do it even more. Your giving poor compressions. Just admit it to yourself.


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## Shishkabob (Mar 16, 2011)

usalsfyre said:


> Repeat after me. High quality uninterrupted chest compressions ARE. THE. ONLY. THING. THAT. MATTERS.



*Cough* electricity *cough*


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## abckidsmom (Mar 16, 2011)

Linuss said:


> *Cough* electricity *cough*




But even electricity needs to be augmented with a few compressions.


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## Shishkabob (Mar 16, 2011)

Not if you press "Shock" fast enough!


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## ffemt8978 (Mar 16, 2011)

Linuss said:


> Not if you press "Shock" fast enough!


Sounds like you're confusing your Taser with your Defib.


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## usalsfyre (Mar 16, 2011)

Linuss said:


> *Cough* electricity *cough*



Alright, you win. Throw electricity in my previous statement for shockable rhythms.

Way to spoil making a point


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## Bullets (Mar 17, 2011)

In the Eastern People's Republic, we usually always transport CPR in progress. i think we worked 2 patients who we ended up pronouncing on scene my entire time as an EMT. so cot surfing is pretty much standard and expected, and i usually am the one who ends up riding the rails. If you lower the cot to the right height, its easy to continue to do high quality two handed CPR while surfing. Ive seen my compressions on the monitor. On the other hand, we have a Level II Trauma Center in my town, so our MAX transport time is like 5-7 minutes and thats for extreme cases, average is like 2-3 minutes


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## 18G (Mar 17, 2011)

Bullets said:


> In the Eastern People's Republic, we usually always transport CPR in progress. i think we worked 2 patients who we ended up pronouncing on scene my entire time as an EMT. so cot surfing is pretty much standard and expected, and i usually am the one who ends up riding the rails. If you lower the cot to the right height, its easy to continue to do high quality two handed CPR while surfing. Ive seen my compressions on the monitor. On the other hand, we have a Level II Trauma Center in my town, so our MAX transport time is like 5-7 minutes and thats for extreme cases, average is like 2-3 minutes



CPR is very ineffective during transport I don't care how good you (general you) claim to be. A cardiac arrest is not a "load and go" call type. For the patient to have the best care and best chance of survival all of your efforts (quality CPR, airway, meds) need to be focused onscene, not during transport. 

It is well recognized that EMS systems have the same capabilities to resuscitate a cardiac arrest patient as do the Emergency Department's. There are some extenuating circumstances but I would guess over 99% of arrests can be handled the same in the field. 

If a ROSC cannot be achieved in the field then it's really time to call Command to cease further efforts. What more is the hospital going to do that hasn't already been done?

"Cot surfing" and all its glory really should be a thing of the past


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## usafmedic45 (Mar 17, 2011)

18G said:


> CPR is very ineffective during transport I don't care how good you (general you) claim to be. A cardiac arrest is not a "load and go" call type. For the patient to have the best care and best chance of survival all of your efforts (quality CPR, airway, meds) need to be focused onscene, not during transport.
> 
> It is well recognized that EMS systems have the same capabilities to resuscitate a cardiac arrest patient as do the Emergency Department's. There are some extenuating circumstances but I would guess over 99% of arrests can be handled the same in the field.
> 
> ...


About the only exceptions should be a hostile scene (family doesn't want to accept that the person is dead and gets aggressive....been there, seen it) or a profoundly hypothermic patient.


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## zmedic (Mar 18, 2011)

18G said:


> If a ROSC cannot be achieved in the field then it's really time to call Command to cease further efforts. What more is the hospital going to do that hasn't already been done?
> 
> "Cot surfing" and all its glory really should be a thing of the past



For asystole sure, but are you really pronouncing PEA/ persistent V-fib in the field? I think those should be transported so the ER can deal with possible causes like electrolyte abnormalities or hypothermia or whatever.


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## usalsfyre (Mar 18, 2011)

zmedic said:


> For asystole sure, but are you really pronouncing PEA/ persistent V-fib in the field? I think those should be transported so the ER can deal with possible causes like electrolyte abnormalities or hypothermia or whatever.



Outside of hypothermia, which should be easily identifiable, how many cardiac arrest are going to have a good outcome after 20 minutes of being pulseless no matter what the rhythm?


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## usafmedic45 (Mar 18, 2011)

> For asystole sure, but are you really pronouncing PEA/ persistent V-fib in the field? I think those should be transported so the ER can deal with possible causes like electrolyte abnormalities or hypothermia or whatever.



Show me a study that says you get a better chance of meaningful survival in non-hypothermic PEA and persistent VF transported to the hospital after failure to obtain ROSC.  Electrolyte abnormalities can be treated in the field and hypothermia to the point of inducing cardiac arrest is exceedingly uncommon and normally pretty obvious.


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## medtech421 (May 3, 2011)

Chief Complaint said:


> Not to thread jack, but ive got a question about CPR as well.
> 
> Compressions/ventilations are supposed to be at a ratio of 30:2, and we are also taught that 2 rescuer CPR is done at 15:2.  But ive only witnessed CPR done at a 30:2 ratio, with multiple healthcare providers on scene.
> 
> What am i missing?



If there is an advanced airway in place, then the person doing compressions will then just go fast and hard for 2 minutes while the individual managing airway provides a breath via BVM every 5 seconds.  2 rescuer CPR for an adult does not change the ratio of 30:2 if no advanced airway is in place.  Children and infants are the only situations where the ratio changes.


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## mycrofft (May 3, 2011)

*Ratios change?*

Is that the "Chilean School of Chiropractic Medicine" standard, the "Stevie Wonder School of Cardiac Resuscitation By Mail" standard, or what? (Ratios are the same, says the brand new ARC instructor's guide here in my hand, especially the "no breaths" technique, whose ratio is "give thirty compressions, don't stop for a rescue breath, give thirty more compressions...".

Sometimes you will be forced into giving less-than-perfect CPR. Don't plan to; plan how _*not*_ to do it wrong and what to do if you get caught short. 

And as to whether or not a hospital can help more than a top flight paramedic or higher mobile unit, most people undergoing CPR are going to die one way or another. In fact, if they are receiving CPR appropriately, they are already clinically dead, but a majority will go on to fail to "go on" (e.g., be organically dead). Give them the best chance, do it right, and don't fall off (or tip over!!!) a litter or gurney because you get excited and climb on board.


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## JOgershok (May 3, 2011)

mycrofft said:


> Is that the "Chilean School of Chiropractic Medicine" standard, the "Stevie Wonder School of Cardiac Resuscitation By Mail" standard, or what? (Ratios are the same, says the brand new ARC instructor's guide here in my hand, especially the "no breaths" technique, whose ratio is "give thirty compressions, don't stop for a rescue breath, give thirty more compressions...".
> 
> Sometimes you will be forced into giving less-than-perfect CPR. Don't plan to; plan how _*not*_ to do it wrong and what to do if you get caught short.
> 
> And as to whether or not a hospital can help more than a top flight paramedic or higher mobile unit, most people undergoing CPR are going to die one way or another. In fact, if they are receiving CPR appropriately, they are already clinically dead, but a majority will go on to fail to "go on" (e.g., be organically dead). Give them the best chance, do it right, and don't fall off (or tip over!!!) a litter or gurney because you get excited and climb on board.



2010 Health Care Provider Guidelines Video from AHA:
http://www.facebook.com/video/video.php?v=1304230741322


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## JOgershok (May 3, 2011)

THE NEW BLS GUIDELINES FOR 2010 FROM AMERICAN HEART


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## feldy (May 4, 2011)

usalsfyre said:


> Outside of hypothermia, which should be easily identifiable, how many cardiac arrest are going to have a good outcome after 20 minutes of being pulseless no matter what the rhythm?




this is why we have a 20 min on scene time when working a code. If ROSC is obtained then we transport, if not the we pronouce.

also my agency has the advantage of having the lucas 2 device so when transporting compressions are still effective.


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## medtech421 (May 4, 2011)

mycrofft said:


> Is that the "Chilean School of Chiropractic Medicine" standard, the "Stevie Wonder School of Cardiac Resuscitation By Mail" standard, or what? (Ratios are the same, says the brand new ARC instructor's guide here in my hand, especially the "no breaths" technique, whose ratio is "give thirty compressions, don't stop for a rescue breath, give thirty more compressions...".
> 
> Sorry,yes ratios change.  Unless the AHA video I have viewed while teaching is wrong.  I mean,what do THEY know.   And hands-only CPR is meant for lay people. I left out that standard and discussed advanced airway placement because this forum is meant for professionals.


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## Handsome Robb (May 5, 2011)

medtech421 said:


> Sorry,yes ratios change.  Unless the AHA video I have viewed while teaching is wrong.  I mean,what do THEY know.   And hands-only CPR is meant for lay people. I left out that standard and discussed advanced airway placement because this forum is meant for professionals.



Hands only CPR is meant for anyone without proper PPE to provide ventilations. Professional rescuers can still end up being in the right place at the wrong time off duty. Or even on duty, grabbing a bite to eat when the bus is parked in the parking lot and it takes a bit of time for you or your partner to retrieve gear.

And sorry, the ratios haven't changed recently. Still 30:2 with proper PPE....


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## marineman (May 5, 2011)

Its not the AHA standard yet but hands only CPR is even making it into ALS protocols now to an extent. My service (100% medic) just changed over to CCR, put a non-rebreather on the patient and place an oral airway then perform continuous compressions immediately. We are still expected to intubate as soon as possible but it is not a first priority. Every time you compress the chest and allow it to recoil there is air exchange within the lungs and typically a single person trying to maintain the open airway while trying to seal the mask and squeeze the bag is not really that effective of a ventilation anyway. Once the tube is placed we follow AHA guidelines. We do have the autopulse which compresses the entire chest more than manual compressions which increases the air movement within the lungs.


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## medtech421 (May 5, 2011)

NVRob said:


> Hands only CPR is meant for anyone without proper PPE to provide ventilations. Professional rescuers can still end up being in the right place at the wrong time off duty. Or even on duty, grabbing a bite to eat when the bus is parked in the parking lot and it takes a bit of time for you or your partner to retrieve gear.
> 
> And sorry, the ratios haven't changed recently. Still 30:2 with proper PPE....



You are absolutely correct about being in the wrong place at the right time and off duty.  If it takes my partner more than 45 seconds to grab a first-in bag out of the truck, I wouldnt be a happy camper, though.  The ratio issue seems to be confusing people.  It is 30:2 for one and two rescuer CPR on *Adults*.  Child and infant ratios change on 2 rescuer CPR to 15:2 I keep getting people yelling me it never changes.  Am I in the only area of the country that treats pediatrics?


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## medtech421 (May 5, 2011)

marineman said:


> Its not the AHA standard yet but hands only CPR is even making it into ALS protocols now to an extent. My service (100% medic) just changed over to CCR, put a non-rebreather on the patient and place an oral airway then perform continuous compressions immediately. We are still expected to intubate as soon as possible but it is not a first priority. Every time you compress the chest and allow it to recoil there is air exchange within the lungs and typically a single person trying to maintain the open airway while trying to seal the mask and squeeze the bag is not really that effective of a ventilation anyway. Once the tube is placed we follow AHA guidelines. We do have the autopulse which compresses the entire chest more than manual compressions which increases the air movement within the lungs.



I was thinking more along lines of BIA such as king or LMA which dont take much longer than an OPA.  I dont normally speak in terms of ET tubes because that is not in my scope of practice in SC.  I really want to get my hands on an autopulse.  I have heard positive and negative about it.  Any insights you can share?


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## mycrofft (May 6, 2011)

*Ah, good old ARC strikes again*

Where's my Aricept again? I keep losing it...
The rest of my statement stands, though. 
Thanks, JOgershok!


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