# CPR Guidelines



## emtontherun (Jun 27, 2014)

Hi all!
I'm about to take my registration EMT exam and I'm studying the CPR portion. I'm just wondering when the appropriate time to do your primary survey and transfer to backboard and load into the ambulance would be? Because it's a load and go situation do I do AED/airway/CPR and skip the primary until my patient has been revived?
If you could help, that would be great, thanks!


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## OnceAnEMT (Jun 27, 2014)

You're taking the term "CPR" far too generically. 

To put simply, lets look at AHA guidelines. First thing you do. "Hey, are you OK? ARE YOU OK?" Shake. Pinch. "You, call 911. You, get the AED." 

A/B - Look. Listen. Feel. Head tilt, chin lift. 
C - Check carotid pulse for no longer than 10 seconds.

You sir, just did your primary assessment. Now start doing compressions if you don't feel that pulse. Cardiac Arrest is not a load and go scenario most of the time. You cannot effectively analyze a heart rhythm in the truck and probably won't be doing effective compressions. Unless you're 2 minutes from the ED, you best be calling ALS and that Pt will be worked on scene. Even in the ED, we have stopped a crew in the entrance and we didn't relocate the Pt into a room and into our bed until a pulse was present. Compressions are the meat of that war.

Here is a flowchart I made while I was prepping for my EMT-B practicals.

Here is that same flowchart, slightly modified to apply to the Athletic Training world. You'll see a CPR algorithm on the right. These are AHA protocols.

You're probably best off hitting Download at the top right of those screens to get a better view.

Trying not to turn this into a AHA vs protocols battle. For your test, AHA AHA AHA.


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## emtontherun (Jun 27, 2014)

Thanks, very useful!


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## chaz90 (Jun 27, 2014)

^^I was typing up a similar post before Grimes beat me to it.

I'm slightly confused by your terminology here. By the time you've determined it's a cardiac arrest, your primary survey is complete. Airway, breathing, and circulation have all been determined to be either absent or compromised and you should be attempting to intervene to some extent on each of them. 

I don't know what part of Alberta you're in, but you should generally be waiting for ALS to arrive and working your arrests on scene. Cardiac arrests should be the farthest thing from "load and go", even on a BLS level. The only interventions known to work (compressions and defibrillation) only work while you're standing still. AEDs won't analyze accurately in a moving ambulance, and effective manual compressions certainly don't happen.


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## emtontherun (Jun 27, 2014)

Oh, I understand that your ABC's or CAB's in this case would be done. I mean the primary head to toe survey. I'm just trying to stay below the 10 minute on scene time you get for the registration exam.


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## teedubbyaw (Jun 27, 2014)

emtontherun said:


> Oh, I understand that your ABC's or CAB's in this case would be done. I mean the primary head to toe survey. I'm just trying to stay below the 10 minute on scene time you get for the registration exam.




There is no cardiac arrest skill where you have to be off scene in 10 minutes. That would be trauma.


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## OnceAnEMT (Jun 27, 2014)

teedubbyaw said:


> There is no cardiac arrest skill where you have to be off scene in 10 minutes. That would be trauma.



Exactly. The 10 minute "golden rule" is strictly for trauma. You can find yourself on scene for 3 hours for a cardiac arrest, and be doing the best damn job ever.

As well, I just want to clarify some of the terms and acronyms you're mentioning, as you are not using them correctly. I'm only being picky because the confusion will nip you on the registry test. 

ABC = Airway, Breathing, Circulation. You got that.

CAB = AHA's acronym for Compressions, Airway, Breathing. This indicates the order of importance, which is widely supported in today's systems. As I mentioned before, compressions are THE most important thing. Next is having an open airway. Studies have shown that merely having an open airway is sometimes more effective than applying some sort of PPV at all. Breathing is the use of your PPV device, which would be a BVM+mask for a NREMT. 

"Head to Toe" - This is a type of assessment, as you corrected yourself. Not the primary assessment, it is considered one of the Secondary Assessments. In the Secondary there is a Rapid Head to Toe or Modified Secondary Assessment. The Modified is used when you know exactly what is going on, ie a forearm fracture secondary to a fall. A Rapid Head to Toe is used when you don't 100% know what's going on, ie Pt experienced LOC. 

Textbook wise, your Primary Assessment (ABCs) covers anything that is worthy of your attention in the event that the Pt is in cardiac arrest (major trauma, airway blockage, etc.). At this point we don't care about potentially fractured ribs or dislocated ankle or discolored left testicle. As seen in the flowchart for ATCs, the algorithm loops in the AHA protocols during cardiac arrest for a BLS provider. You have no reason to go elsewhere, as it simply doesn't matter. Your focus is compressions, early defib, and getting ALS on scene to get meds on board.


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## emsbroadcast (Jun 28, 2014)

emtontherun said:


> Hi all!
> I'm about to take my registration EMT exam and I'm studying the CPR portion. I'm just wondering when the appropriate time to do your primary survey and transfer to backboard and load into the ambulance would be? Because it's a load and go situation do I do AED/airway/CPR and skip the primary until my patient has been revived?
> If you could help, that would be great, thanks!



CAB - Compression, Airway, Breath.

Check on the AHA website, they have a quick guide online available.


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## rabidrider (Jul 27, 2014)

Grimes said:


> You're taking the term "CPR" far too generically.
> 
> To put simply, lets look at AHA guidelines. First thing you do. "Hey, are you OK? ARE YOU OK?" Shake. Pinch. "You, call 911. You, get the AED."
> 
> ...




That is a really good flow chart. To bad I just got it now instead of before taking the practical exam. However I have a probably dumb question and I am sure after getting the answer I will slap myself but..... On the flow chart where you determine level of responsiveness you have unresponsive or AnOx#. What is AnOx#? I dont remember ever hearing anything like that before. I know the AVPU scale and GCS but have never heard of AnOx#.

Sorry if it is a dumb question but I will never know unless I ask.


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## DesertMedic66 (Jul 27, 2014)

rabidrider said:


> That is a really good flow chart. To bad I just got it now instead of before taking the practical exam. However I have a probably dumb question and I am sure after getting the answer I will slap myself but..... On the flow chart where you determine level of responsiveness you have unresponsive or AnOx#. What is AnOx#? I dont remember ever hearing anything like that before. I know the AVPU scale and GCS but have never heard of AnOx#.
> 
> Sorry if it is a dumb question but I will never know unless I ask.



Alert and Orientated x 1,2,3, or 4. It's the Person, Place, Time, Purpose/Event questions you are supposed to ask patients to find out if they are altered.


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## drl (Jul 27, 2014)

rabidrider said:


> That is a really good flow chart. To bad I just got it now instead of before taking the practical exam. However I have a probably dumb question and I am sure after getting the answer I will slap myself but..... On the flow chart where you determine level of responsiveness you have unresponsive or AnOx#. What is AnOx#? I dont remember ever hearing anything like that before. I know the AVPU scale and GCS but have never heard of AnOx#.
> 
> Sorry if it is a dumb question but I will never know unless I ask.



I've usually seen it written A/Ox4, but it just means "alert and oriented times four." The four questions you ask gauge the patient's awareness to:

1.- Person: "What is your name?"
2.- Place: "What city are we in?"
3.- Time: "What day of the week is it?"
4.- Events Leading Up to Incident: "Can you tell me what happened?"

EDIT: Whoops, beat to the punch


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## rabidrider (Jul 27, 2014)

I knew I would want to slap myself after hearing the answer but I had to ask I have never seen it written like that. I will toss it up on paint and make a note on there. All in all its a really cool flow chart. 

Thanks


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