Rescue breaths
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18G
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Yes, if during the initial assessment you find the patient not breathing you want to give 2 rescue breaths before continuing to check for a pulse.
Anytime a patient is not breathing you need to give rescue breaths regardless of pulse or not.
Anytime a patient is not breathing you need to give rescue breaths regardless of pulse or not.
Jeffrey_169
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18G is precisly correct.
medichopeful
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After the AED tells you to resume CPR. Other than that, there is NO time (that I know of) where you would go straight to chest compressions.
You might also go straight to chest compressions on a child with a pulse rate of 60 or below with signs of poor perfusion. But that would probably be situation dependent. Hopefully someone more educated could jump in and correct me if I'm wrong.
You MIGHT (I haven't learned it) go straight to compressions (without breaths) when doing compression-only CPR. Not sure though. I'd check another source before doing it.
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Shishkabob
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You provide air when your patient isn't getting enough of it on their own... they don't necessarily have to be apneic. If they are breathing 2 times a minutes, are you going to wait till they stop?
CollegeBoy
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I do not even go straight to compressions here, my protocols have us check for a pulse and apneic after every shock. Then two more breaths before continuing CPR.
Okay, check this out. Let's say you arrive to find bystanders performing cpr. Do you trust that their CPR was done correctly and instantly hook up AED or immediately begin chest compressions or do you give 2 rescue breaths right off the bat? Sorry for all the questions but things get confusing when there are so many variables.
In most cases you would ask them to stop and stand back, then begin your assessment from the beginning. Bystanders have been known to do CPR on people who are breathing and have a pulse, or on someone who has obvious signs of death which EMTs would not work. Never trust a bystander blindly.
medichopeful
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We were taught to just go straight to compressions after every shock/no shock (within reason. If they get up and start walking around we wouldn't do compressions
).Our clinical guidelines recommend to do 2 minutes of CPR if we have not personally witnessed the arrest.
Now that said if I roll up to a cardiac arrest with somebody doing CPR I'm probably gonna slap on the pads, have a look at the monitor and give the patient a toasting.
An Officer I know was telling us of an arrest he had on Friday, the guy kept flip flopping between sinus rhythm and VF; so "oh we just kept smashing him in the chest with my fist and he would convert back" .... Johnny and Roy would be proud! B)
Now that said if I roll up to a cardiac arrest with somebody doing CPR I'm probably gonna slap on the pads, have a look at the monitor and give the patient a toasting.
An Officer I know was telling us of an arrest he had on Friday, the guy kept flip flopping between sinus rhythm and VF; so "oh we just kept smashing him in the chest with my fist and he would convert back" .... Johnny and Roy would be proud! B)
With kids respiratory problems are usually high up on the list of causes of arrest, or even poor perfusion.
Rogue Medic
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We should assess the quality of the lay person CPR. It should be obvious pretty quickly if they are doing good CPR. Unless they need to be relieved (bad CPR or too tired), have them continue compressions while we apply the defibrillator pads. We should treat anyone performing lay person CPR with respect.
If the patient is resuscitated and survives with an intact brain, it will probably be because of good lay person CPR.
"We strongly recommend that patients not be moved while CPR is in progress unless the patient is in a dangerous environment or is a trauma patient in need of surgical intervention. CPR is better and has fewer interruptions when the resuscitation is conducted where the patient is found."
In other words, there is rarely a good reason to transport dead people.
"The rescuer should not delay resumption of chest compressions to recheck the rhythm or pulse."
When a shock is delivered, it is only a single shock, then we immediately resume compressions. Immediately.
I expect that the next revision of the guidelines, which should come out next year, will discourage initial ventilation in witnessed adult VF/Pulseless VT patients until after several minutes of compressions. The research on compression only CPR is showing much better outcomes for these patients.
The two important things are continuous compressions and defibrillation - not ventilation. The main objection seems to come from those who think that tradition is more important than science, that tradition is more important than improving patient care.
Respiratory patients, pediatric patients, and other rhythms would not be treated with only compressions, since these patients may actually benefit from early ventilation.
"Adjusted neurologically intact survival after witnessed ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest was higher for passive ventilation (39/102; 38.2%) than bag-valve-mask ventilation (31/120; 25.8%) (adjusted odds ratio [OR] 2.5; 95% confidence interval [CI] 1.3 to 4.6)."
This is just the most recent study by Dr. Ewy. There are plenty of other studies showing similar improvements in outcomes with continuous compressions.
Offtopic, but what the hell...
I wouldn't be to surprised if this happens; switching to CCR instead of CPR (or just renaming CCR CPR which is more likely) and from the published results of the trials this would actually be a good thing. BUT as far as I know (and if you or anyone else knows differently then please post it) there hasn't been a study that compares CCR to the new CPR/ACLS standards. That does need to be looked at before any change get's made.
Your guidelines are exactly the current standard. Non wittnessed, or more than 5-6 minutes response time...2 minutes, shock or no shock, 2 minutes then shock or no shock, check the victim...2 minutes and so on. Of course this is BLS, not ALS. Interventions begin when the first 2 minutes of CPR is complete in an ALS setting. ALS still has to get that circulation restarted if they didn't see (or good CPR wasn't being provided) gramps go down.
dudemanguy
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So when do you normally recheck for a pulse?
You do your first pulse check after giving 2 breaths....then begin cpr or go right to the AED depending on circumstances, but when should you recheck for a pulse?
After a shock is delivered or theres no shock advised you immediately resume compressions right, so when would be a good time to recheck the pulse, when compressions are paused to give 2 breaths? and how often do you recheck for a pulse, at some point during every 2 minutes and 5 cycles of cpr?
I'm curious what the AHA guidelines are on this, I believe they just tell you to continue CPR until the patient either moves or begins breathing on their own, and dont call for rechecking the pulse unless one of those occurs.
You do your first pulse check after giving 2 breaths....then begin cpr or go right to the AED depending on circumstances, but when should you recheck for a pulse?
After a shock is delivered or theres no shock advised you immediately resume compressions right, so when would be a good time to recheck the pulse, when compressions are paused to give 2 breaths? and how often do you recheck for a pulse, at some point during every 2 minutes and 5 cycles of cpr?
I'm curious what the AHA guidelines are on this, I believe they just tell you to continue CPR until the patient either moves or begins breathing on their own, and dont call for rechecking the pulse unless one of those occurs.
Needles17
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This is a simple process. It is ABC for a reason. Check you airway to see if it is patent. Look Listen and feel means look in airway and for chest rise, listen and feel for air movement. Give two breaths if apneic or absent resp. Then check for a pulse at carotid for 5 to 10 seconds. If no pulse compressions for 5 cycles if unwitnessed by a healthcare provider. If you can not fix the airway, does it really matter if you have a pulse or not? Soon enough you will not have one anyway without a patent airway. Reassess after every 5th cycle of compressions. If you get ROSC remember AHA guidelines 2005 state continue compressions for another two minutes.
Needles17
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This question got blown out of the water and went down the crazy train. Rescue breaths are for pt's with a pulse but not breathing. That simple.