# Cardiac Arrest Management practical



## C2F2Girl (May 19, 2008)

I have my practical set for this weekend on Sunday. I'm really nervous since it's my first time going. I'm in the fire service and it's my foremost passion and love, however, I realize the need to have at least basic level ems training. However, I am confused about one aspect of the emt-b AED station though... In class, we were given the skill station sheets directly off the nremt website but my state practical exam uses their own sheets adapted from them so they do vary quite a bit. On the national registry sheet, cpr is being performed and the candidate has to stop cpr to analyze with the AED. On my state sheet, it says:

verbalize bsi
question bystanders about arrest avents
performs initial assessment - check abc's
turns on AED
attach pads
clear pt
analyzes rhythm
resumes cpr
requests ALS
inserts airway adjunct
ventilates pt to chest rise
verbalizes flow rate of 15 lpm via bvm
assures cpr continues uninterrupted for no more than 10 seconds
checks abc's
performs 1 person bvm
performs 2 person bvm


We were taught in class that cpr would be in progress. What confuses me is when it says "resume cpr" but never states when it should have been initiated. So far no one in the class of 30 ppl has passed the national registry exam or practicals as our class left much to be desired. Only 7 ppl passed the course. I hope to sit for the computer based test within the next month.

Thanx!
Nicole


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## MedicDoug (May 19, 2008)

How about this... when you "question bystanders" ask "how long have you been doing CPR?"
Or ask the proctor "is CPR in progress?"

Or, after checking abc's (and finding apnea and pulselessness) state "start cpr" if you have a partner.

I'd review the AHA sequence as well before the test, although this should be part of your muscle memory by now!

Remember the point is to interrupt CPR for the shortest possible time, and shock (if advised by the AED) as soon as possible.

Good luck


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## C2F2Girl (May 19, 2008)

Thanks for taking the time to reply, those are some good suggestions I was considering as well...... Does anyone know the CPR/AED protocol for New Hampshire and the EMT-Basic practical station? Should CPR be performed during the initial assessment before the first shock? perhaps I should have been more specific.


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## MSDeltaFlt (May 19, 2008)

Does your check off sheet also have a list of critical criteria?  The NREMT does.  As long as you don't do anything on that critical criteria list, then you should pass; regardless of the state.


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## C2F2Girl (May 19, 2008)

Yes, it has 10 CC. I'm worried about the last one, "Did not preform CPR application to standards as appropriate" which is a catch-all for any mistake made during CPR. The first Critical Criteria states "Did not initiate first shock within 90 seconds" so I know 5 cycles cannot be performed as that would be approx. 2 minutes of CPR. So I am unsure if I should state "start CPR" to my assistant WHILE I turn on the AED and attach pads or not at all. *sigh*


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## MSDeltaFlt (May 19, 2008)

Talk to your instructor.  Get him/her to explain the discrepency on the check off sheet.


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## C2F2Girl (May 20, 2008)

Someone actually located the protocol for me and it is cpr before shock but yeah, I'll give my instructor a call and get her input. It's probably a good idea to go straight to the source here and ask her thoughts/tips/advise about the initial assessment.


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## fenris911 (May 21, 2008)

*confussed*

We have had two differnent sheets.  One appears it may be older and the other appears to be a little like the one the posters showd on this thread -- it does not say stop cpr by the bystander, but the critical points include: "did not necceitate use of AED."

I have great instructors --experience wise, but when it comes to testing criteria, NREMT and so on , they arre lost and do not know what is going on for sure.  I have spent too much time and money to be failed because my instructors told me something different than what the portors willl be looking for

so what is the real deal onthe cardiac arrest mangaement?  Our state use stonly the NREMT practicals and written.


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## C2F2Girl (May 22, 2008)

Fenris, are you in NH? I talked to my instructor and she advised to have the assistant perform the initial assessment (abc's) and initiate cpr while the AED is being prepared and stopping cpr as soon as the pads are in place to analyze.


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## fenris911 (May 22, 2008)

thanks for the reply.

this is the problem -- i have been shwon to do it the way you just stated, and then shown to check pulse before using the AED to anylyse 
... to estabish need , i guess.

still confused.  i have tried to contact some recently certified EMT-Bs i know, but could not find them.


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## uctke283 (May 22, 2008)

The other thing I would do is turn on the AED and get it ready as soon as you get on scene, while questioning bystanders about the incident - i believe dealying aed is a critcial failure?


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## fenris911 (May 23, 2008)

Thanks.
One more question: where I would check effectiveness of compressions and ventilations, what would be the best way to show that the ventilations are effective, assuming they may not use the "Rescue Annie" w/the indicator light?


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## MSDeltaFlt (May 23, 2008)

fenris911 said:


> Thanks.
> One more question: where I would check effectiveness of compressions and ventilations, what would be the best way to show that the ventilations are effective, assuming they may not use the "Rescue Annie" w/the indicator light?



Adequate rise and fall of the chest.


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