# New ACLS standards; continue CPR even as shock?



## Hockey (Aug 21, 2010)

I got certified a few months ago on the old standard but keep hearing people talking about how you continue compressions even as you are defibrillating.


Seriously?


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## reaper (Aug 21, 2010)

It is not being taught that way yet.

But yes, Studies have shown with pads, there is not much risk of shock.


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## Shishkabob (Aug 21, 2010)

Well, it's not "new standards" yet considering the new revisions don't come out till later on this year.

But it's been tested for a while that there is no harm at being hands on while doing defibrillation... and from a study I've seen (granted only on animals) that there is a much higher chance of successful defibrillation during the upstroke of compressions.


Article on hands on-- http://circ.ahajournals.org/cgi/content/short/117/19/2510


Can't find the article with the numbers, but here's the one on the upstroke  http://www.ncbi.nlm.nih.gov/pubmed/20042857


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## firecoins (Aug 21, 2010)

the 2005 standards, have people pumping as the machine charges up and not during the shock. 

Are these rumors on the new 2010 standards?


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## AtlantaEMT (Aug 21, 2010)

Don't a lot of the new AEDs use a dual-phase defib or something along those lines which uses a lot less energy?  Then again don't you need to stop compressions to analyze?

I just finished school and had my AHA CPR course 4 weeks ago and even with the NREMT tests they tell you to clear the patient.  I do see the point of doing compressionss during defib but I'm stealing some GA Power utility gloves for when I do it.


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## medicRob (Aug 21, 2010)

firecoins said:


> the 2005 standards, have people pumping as the machine charges up and not during the shock.
> 
> Are these rumors on the new 2010 standards?



Let Brown test it. We should know what is going to change in Nov. 

[Temporarily removed til I find research to back me up, and it is not just hear-say]
(I am finding peer reviewed research or manufacturer's notes to back up what I said here, be patient)


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## MasterIntubator (Aug 21, 2010)

We have toyed with that many months ago, and double gloving worked well.  At that point, it was more of a factor of who was going to do it with confidence... as many of us were like... "Not it".

Zoll has the rectilinear biphasic ( and the patent ), which claims to be superior as far as sudden current waveform spike reduction, thus not needed anything above 200j.  Most of the rest of the biphasics are truncated and still spike the waveform in someway or form. Which is one reason LP12/15 still advise going up to 360j

Google-ize it... its interesting how the companies really compare each other.... like a shoot out.


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## firetender (Aug 22, 2010)

*Tell me if this has changed*

Way back when, I used to grease up paddles, charge them to deliver a 400 joules jolt, place them on a patient, call out something like "Everybody clear!" and push a button (actually, two buttons simultaneously if I remember right).

Today, I understand, you slap on a couple pads (same location as placement of paddles) and hit a button when the light goes on, basically it does the above, some AED's even call out a warning as well.

When I used to do this, there were actually a couple times when, by whatever twist of fate, I defibrillated a beating heart. What happened? The patient's heart *stopped *beating and began fibrillating and the patient started seeking that ole white light! Of course, then I had to bring it and the patient back again.

What's the point? As far as I'm concerned, THAT is what happens when you defibrillate a heart that is beating; it stops beating. I've seen it; I've DONE it. When your heart stops beating for long enough, you die. 

What could you possibly say that would prompt me to have my hands in contact with a body at the same time a jolt powerful enough to stop my heart is being applied to it?

Better yet, who here with more than one year's experience in ALS will give this new approach a try?


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## CAOX3 (Aug 22, 2010)

I remeber a few providers hitting the floor after not heeding the warning, I cant remember if they were paddles or pads.

Forgive me but Im not volunteering for that mission just yet.  I have been electricuted twice once at 110v and again at 220v.  No thanks.


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## Hockey (Aug 25, 2010)

I said it before and I'll say it again, stopping compressions for what...2-3 seconds if that will not kill the patient anymore


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## gicts (Aug 25, 2010)

Seems like too big of a legal risk for the manufacturers and ambulance companies to comply, even if it were to surface that defibrillators only shock the intended person.

That one time in that one place, somehow it will shock someone else, and hell will be raised ^_^


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## Lifeguards For Life (Aug 25, 2010)

Hockey said:


> I said it before and I'll say it again, stopping compressions for what...2-3 seconds if that will not kill the patient anymore



you should probably stop saying that


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## Shishkabob (Aug 25, 2010)

Lifeguards For Life said:


> you should probably stop saying that



Well, it's technically true.



You can't kill dead.


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## Melclin (Aug 26, 2010)

Why not have a simple insulating pad between you and the patient.

I could head down to Bunnings right now and solve this debate.



Granted though, even with an insulator, being close enough to do compressions would put you at greater risk. But there are simple ways around that too. 

Basically, if they need continuous compressions, then we can figure out a way to do it safely.


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## MasterIntubator (Aug 26, 2010)

Hockey said:


> ......, stopping compressions for what...2-3 seconds if that will not kill the patient anymore



And that is not what the 2005 study found.  Every stop is detrimental.  Your chances of getting a response rides on that.
It takes about 1 minute of compressions to get somewhat good circulation/perfusion in the heart with CPR.  ( that is what changed the 2005 standards... that beautiful color ultrasound gave light of the CPR physiology ).

Each time you stop and the flow action halts.... you have to work another minute to get that perfusion back up.   So the theory is, don't stop and keep the flow going.

Guess we will see how it pans out.


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## Lifeguards For Life (Aug 26, 2010)

Linuss said:


> Well, it's technically true.
> 
> 
> 
> You can't kill dead.



I am of the firm belief that you can, in fact make a patient 'more dead'.


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## fma08 (Aug 26, 2010)

Lifeguards For Life said:


> I am of the firm belief that you can, in fact make a patient 'more dead'.



+1

Dead is bad enough, you don't need to make it worse.


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## Smash (Aug 26, 2010)

fma08 said:


> +1
> 
> Dead is bad enough, you don't need to make it worse.



Zombies? 

Remember Rule 4.

Seriously though, whilst the rationale is sound, this will be a difficult change for those of us who have been in the field for a while to adapt to. It is such an ingrained habit to stand back with hands in the air when defibrillating that it will take a while to overcome that.


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## CAOX3 (Aug 27, 2010)

Hockey said:


> I said it before and I'll say it again, stopping compressions for what...2-3 seconds if that will not kill the patient anymore



Actually there is dead dead and viable dead and everytime you take you hands off that patients chest they become more dead dead and less viable dead.  Wow..im dizzy.

Im with Melclin insulation may be the key and we have plenty of riders around here to conduct clinical trials


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## Hockey (Aug 27, 2010)

I would just like to sit back and watch someone actually do this very thing.  I'll buy them a case of beer and a pizza too if they do it with various monitors (all while hooked up to one themself)


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## Lifeguards For Life (Aug 27, 2010)

Smash said:


> Zombies?
> 
> Remember Rule 4.
> 
> Seriously though, whilst the rationale is sound, this will be a difficult change for those of us who have been in the field for a while to adapt to. It is such an ingrained habit to stand back with hands in the air when defibrillating that it will take a while to overcome that.



I'm only a recently graduated paramedic, but clearing the patient before defibrillation was a critical failure in our finals and megacodes. We had a handful of classmates fail their final megacode for failing to verbalize clearing the patient before defib.


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## MasterIntubator (Aug 27, 2010)

You are so correct, Lifegaurd.  It still is.


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## MasterIntubator (Aug 27, 2010)

CAOX3 said:


> Actually there is dead dead and viable dead and everytime you take you hands off that patients chest they become more dead dead and less viable dead.  QUOTE]
> 
> I like that analogy!


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## mikie (Sep 10, 2010)

Do automated CPR machines (i.e. AutoPulse) stop during defibrillation?


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## MasterIntubator (Sep 10, 2010)

Not that I am aware of, we never did....  but to get an underlying rhythem... you gotta pause for a second or two.


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## Hockey (Sep 12, 2010)

Can anyone provide a link to this new updated standard if its out yet?


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## Melclin (Sep 12, 2010)

Hockey said:


> Can anyone provide a link to this new updated standard if its out yet?



They're not out yet.



Is anyone else excited to see what the changes will be?

Man I'm such a nerd. B)


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## LondonMedic (Sep 12, 2010)

mikie said:


> Do automated CPR machines (i.e. AutoPulse) stop during defibrillation?


TTBOMK, they don't. But I've never seen one used for anything that's not asys or PEA.


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## Hockey (Sep 12, 2010)

Melclin said:


> They're not out yet.
> 
> 
> 
> ...




When do they come out again?


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## medic417 (Sep 12, 2010)

Looks like October but the books will not be released with the updates until next year some time in the summer probably.  So if you take ACLS you probably will be taught current guidelines for the next several months.  What is funny about this rumor is the ACLS instructors have not even been told what if any changes have been made to the guidelines yet.  So not sure where people have come up with this rumor.


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## MrBrown (Sep 12, 2010)

Why its quite simple, never let wild rumor and speculation get in the way of fact


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## medic417 (Sep 12, 2010)

MrBrown said:


> Why its quite simple, never let wild rumor and speculation get in the way of fact



No you have that wrong.  Never let facts get in the way of wild rumors and speculation.


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## bayoumedic (Nov 3, 2010)

maybe they ment to say continuing cpr if using an auto pulse


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