# Possible cardiac arrest



## rhan101277 (Sep 23, 2008)

You are dispatched to a possible cardiac arrest at a quik-stop gas station.  You arrive to see two bystanders performing CPR.  What do you do?


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## mikie (Sep 23, 2008)

From a BLS point of view...

Have bystandards stop CPR, check for pulse, throw in ambulance (regardless of pulse) and do the BLS thing from there (CPR, AED, Airway) call it in, haul a$$ (once AED has analyzed at least once), call for ALS*

*This also depends on location.  Is this gas station close to a hospital, ALS available/near by?  Do they have slushees (coke preferebly)?

edit:  ...bsi & scene safety and all of that jazz


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## rhan101277 (Sep 23, 2008)

Great this was one of my test questions tonight.  I put have bystanders stop CPR and asses the pt.  There were two other choices I easily did away with.  The other was contact a ALS unit and get a AED.  But you just can't say, "well if they are performing CPR he must be in cardiac arrest".  You verify yourself and then being treatment from there.  That answer was a tough call for me, but looks like I made the right decision.


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## KEVD18 (Sep 23, 2008)

wow...the scenario question posted here have really gone down hill lately.


asses the patient and determine whetheror not the patient is currently alive.

if they are, treat appropriatley.
if they arent, treat appropriatley.

i dont think theres really much variation to how a code get worked. if your bls, airway, cpr and aed. if your als, airway, cpr, monitor/defib, drugs.


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## traumateam1 (Sep 23, 2008)

I WOULDN'T have them stop CPR right away. I would get everything set up. OPA, O2, BVM, AED, then ONCE we were all set up I would stop CPR and assess B and C. No B or C than pop in OPA, give 2 breaths and go ahead with CPR and then regular CPR protocols. No ALS here so wait for either 30 minutes, 3 consecutive No Shock Orders, DNR is shown. Call MD and then go ahead with his/her orders.


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## mycrofft (Sep 23, 2008)

*Clap time?*

Activate EMS, order a burger to go, and casually look around for an AED.
Well, skip the burger.
(Since I'm not on the street anymore I'd be on my own time, no uniform).


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## mikie (Sep 24, 2008)

traumateam1 said:


> I WOULDN'T have them stop CPR right away..



What if the person really isn't in cardiac arrest?  Perhaps the person passed out (syncope, thousand other reasons) and they infact have a pulse.


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## KEVD18 (Sep 24, 2008)

first thing to do: asses the patient! to do that, you have to have the bystanders stop cpr. they stop, you check a pulse, and then have them continue while you assemble your gear if appropriate.

conversely, you could let the bystander continue to beat the crap out of the patient while he still has a pulse that they couldnt find while you caually lay out all your gear.

oh and one other thing, if any of your code gear requires more than two steps to bring it into action, it isnt being stored properly.


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## traumateam1 (Sep 24, 2008)

I'd rather have all my junk set up and ready to go (which takes around a minute) than have to go into CPR and then my partner is getting it all ready. Does CPR cause any harm? We'll we do chest compressions for a unconscious p/t right? So another minute of CPR isn't going to hurt. There is more harm done in interupting CPR than not... so unless they are tired or clearly not providing effective compressions than I wouldn't stop them right away.


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## KEVD18 (Sep 24, 2008)

traumateam1 said:


> I'd rather have all my junk set up and ready to go (which takes around a minute) than have to go into CPR and then my partner is getting it all ready. Does CPR cause any harm? We'll we do chest compressions for a unconscious p/t right? So another minute of CPR isn't going to hurt. There is more harm done in interupting CPR than not... so unless they are tired or clearly not providing effective compressions than I wouldn't stop them right away.



you're joking right?

YES! CPR does harm. it causes major trauma to the chest. the harm it does is usually mitigated by the fact that you cant make a dead person deader but in the event of an un(professionally)confirmed dead person, you have to verify that they are actually dead ASAP. consider this: the patient had a syncopal episode. since lay people are no longer taught a pulse check(because its been proven time and time again that they cant), two eager beavers jump right into cpr that is unnecessary. lets say you have a response time of 5 minutes, so thats how long this has been going on. now you want to add another minute to this completely unnecessary process while you fiddle about with your kit? to avoid what, a 5 second interruption?

"we do chest compressions for an unconscious patient right"

please tell me that by unconscious what you really meant was unconscious unresponsive and pulseless right? please tell me you dont start banging on the chest of every patient you make contact with that isnt conscious.


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## rhan101277 (Sep 24, 2008)

I am sorry for the sub-par question.  To someone in class, the answers sometimes aren't so obvious.  Cause they pound in don't stop CPR etc. etc. and here you have to make a determination to make someone stop so you can assess.


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## BossyCow (Sep 24, 2008)

I would probably get them to stop CPR long enough for me to determine if CPR is needed. I've seen too many cases of "CPR" done on the buddy who passed out drunk, the postictal seizure pt, and the completely dead. Just a few calls ago, came in on bystander CPR on a pt who was in respiratory arrest due to a brain stem bleed. She had a pulse, didn't need compressions but we don't teach bystanders to take pulses anymore......


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## traumateam1 (Sep 24, 2008)

I wanna appologize to everyone. My posts again made little sense. I had a really bad headache.. almost a migrane and I was about to go to the ER becuase it was so bad.. so instead of going to bed I decided to try and think and post on EMTLife and of course my posts were horrible! lol. Let me correct my self.



> We'll we do chest compressions for a unconscious p/t right?


I ment for an unconscious choking person.


> Does CPR cause any harm?


I know it causes serious chest trauma.. however they have already been doing CPR.. the damage is done, the ribs are cracked/broken or whatever. What I ment was if they teach people to do CPR for an unconscious choking p/t than continuing CPR for another (roughly) 60 seconds wont do too much more damage. They're going to the hospital anyways and they will get checkout out.

I hope I didn't confuse anyone or make them second guess my posts. I guess I would have to see what the p/t was like. If they are cyanotic and looking FUBAR'd than I wouldn't stop them.. if they were normal colour and looking like it might be a syncope episode than I'd probably stop it.


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## beachemt (Sep 24, 2008)

Id say i disagree that it your stuff take time to set up your not storing it properly. I was alwasy told that you keep letting them go and set up your stuff. Now I agree i would check for pulse first and then set up stuff but on the NREMT scenarios im pretty sure you keep the bystanders going until you have all of your gear set up so you dont have to stoff later to set things up.


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## reaper (Sep 24, 2008)

Do you proof read these posts?


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## mycrofft (Sep 24, 2008)

*Not choking, pulseless.*

Deep breath, take the Imetrex...


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## traumateam1 (Sep 24, 2008)

I can't win I GIVE UP!


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## YouthCorps1 (Nov 13, 2008)

Well first of all I would get a scene size-up...was this witnessed or unwitnessed...if witnessed how did he collapse? grab a SAMPLE hx...anything weird to eat, happen before, acting strange lately? the scene is safe proceed in. thank the bystanders and relieve them. if this was a fall, or there is a chance of spinal injy...hold stablization...but thats not my concern. perform ABCs...check vitals...start a 12 lead on the monitor...still asystole then when my partners are already doing compressions, get my BVM ready...if needed oral or nasal airway (prefer oral). bag...have ALS start fluids...get my AED ready, and suction ready...shock this guy!!!!!CLEAR! rapid transport


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## KEVD18 (Nov 13, 2008)

YouthCorps1 said:


> Well first of all I would get a scene size-up


ok



YouthCorps1 said:


> ...was this witnessed or unwitnessed...if witnessed how did he collapse?


still with you



YouthCorps1 said:


> grab a SAMPLE hx...


to a point, depending on available resources. if you've got an extra jake or canary floating around, sure.




YouthCorps1 said:


> anything weird to eat,


rrriiiiggghhhttt....it was the 7/11 chili dog.




YouthCorps1 said:


> happen before,


eeeeeehhhhhhhh......



YouthCorps1 said:


> acting strange lately?


right. changes in behavior are relevant in lots of medical scenarios. in terms of cardiac arrest, its pretty far down on the list. like, very very near the bottom



YouthCorps1 said:


> if this was a fall, or there is a chance of spinal injury...hold stablization...


good



YouthCorps1 said:


> but that's not my concern.


huh? whos job is it? dpw? electric light dpeartment? 



YouthCorps1 said:


> perform ABCs


we're just getting to this?



YouthCorps1 said:


> ...check vitals...


please tell me these are out of order



YouthCorps1 said:


> start a 12 lead on the monitor...


how is a twelve lead going to help you here? your going to stop cpr for the amount of time it takes to analyze and print a XII lead when it wont even help you? III is all you need in a code



YouthCorps1 said:


> get my BVM ready


so we've not been ventilating the patient all along?



YouthCorps1 said:


> if needed oral or nasal airway (prefer oral).


when is an airway adjunct *not* indicated in a code?



YouthCorps1 said:


> have ALS start fluids


if you mean start a line to give drugs, sure. but if you mean give crystalloids, uuuuummmmmmm........dont we have more important things to worry about.



YouthCorps1 said:


> get my AED ready,


wait a minute. you;ve already done a XII lead and have medics running ivns and now we're going with an aed?



YouthCorps1 said:


> shock this guy!!!!!


regardless of rhythm right? just shock the hell out of him?



YouthCorps1 said:


> rapid transport


yeah, thats going to help him.....



sorry dude, i know its a harsh response for you first post; but thats the least accurate, most convoluted crap shoot of a code algorithm ive ever read.


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## traumateam1 (Nov 13, 2008)

YouthCorps1 said:


> Well first of all I would get a scene size-up...was this witnessed or unwitnessed...if witnessed how did he collapse? grab a SAMPLE hx...anything weird to eat, happen before, acting strange lately? the scene is safe proceed in. thank the bystanders and relieve them. if this was a fall, or there is a chance of spinal injy...hold stablization...but thats not my concern. perform ABCs...check vitals...start a 12 lead on the monitor...still asystole then when my partners are already doing compressions, get my BVM ready...if needed oral or nasal airway (prefer oral). bag...have ALS start fluids...get my AED ready, and suction ready...shock this guy!!!!!CLEAR! rapid transport



I don't even know where to start. I know...

*See KEVD18's Post*


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## marineman (Nov 13, 2008)

Spot on Kev. I wonder what kind of youth corps is running and interpreting 12 leads but needs to wait for ALS to start a line?


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## KEVD18 (Nov 13, 2008)

further review has revealed that this character is 15 years old. nothing he says that isnt a question is relevant.


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## Ridryder911 (Nov 13, 2008)

Actually, he/she is right with the current text. Which itself is shameful. Sorry, not attempting to hijack the thread; but youth has no purpose or reason in the healthcare business until of adult age. There is multiple reasons that has been discussed previously. 

Do and perform adequate CPR, something anyone and everyone can do until professional help arrives (ALS). 

R/r 911


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