Full Arrest

[mikie]

Sorry, but like it or not, I am glad I do not have to depend upon your EMS services, if this is representation of the type of care delivered.

I'm sorry, but that is out of line- insulting someone else's EMS. They made a mistake in an intense situation. Is your patient care perfect? I'm not insulting you, but you have SO MANY years over a lot of us. He came here to learn from his mistakes, not be ridiculed.

Carry on!

 

[emtwacker710]

alright, never mind, forget I brought any of this up, I mean I really came here looking for reason for the large volume of vomit and ways to prevent it, not to be lectured on my skills that I and my team members consider profecient, I personally and my other team members think that I handled the situation well

 

[Ridryder911]

One should not have to go to a forum to obtain the very basics of CPR care. This topic is discussed in detail in the health care provider portion of the AHA BLS, which is taught and required in every state. Sorry, but one should not be "learning" the essentials of basic care and use the forums to obtain treatment modalities, rather forums are used to discuss new, different, and review treatment modalities. I am sure the forum managers as well, do not want to be responsible for those would acclaim that they obtained their knowledge based upon this forum or any forum for treatment information.

Sorry, but as I stated, if the call occurred as described then the patient never had a chance. Did it matter, probably not on this one. An elderly patient that had a AMI, aspiration, and if the truth to be known, resuscitation measures probably should had never been started. Again, that is irrelevant. If this case, was brought up in EMS news as a litigation case, most posters would be pouncing on "how poorly trained", and "things like this should never occur". If this event had been described this on a child, I believe the support of the original poster would be different. I just stated the facts based upon the original posters description and stand by that. Four rescuers on one call, and NO one took charge, no one controlled the airway, and basically if one does not know there is "no muscle control" on an patient in an arrest or "they look dead" concerns me and it should anyone in the health field.

If I was an attorney, I can assure you I would be definitely be interested. Sorry, this is common knowledge on how to prevent and decrease vomiting, again it is taught in the national standard of EMT, and again in basic CPR. Since it was not used, or even discussed that it was known, there is possible risks to both parties

I much rather be criticized by peers on a forum, than be in front of a jury. Sorry, I have been an expert witness in cases, and apparently many you of have not witnessed court cases involving EMS. I can assure you they are brutal. If I was the nursing home nurse, I can assure you the State EMS division would be notified that same day for an investigation. Sorry, an EMS service should schedule those with experience with the inexperience this is not fair to the patient, the staff members, and others involved in patient care. I realize it is a volunteer agency, and again just because it is; does not excuse anything. Members should not be released until some experience and competency is obtained, this is the Chief's, administration, responsibility to assure this.

A cardiac arrest is NOT an intense situation, rather the patient cannot deteriorate any further. Dead is the most critical point they can become, the patient can't get any worse than that. In fact cardiac arrest is one of the easier situation to provide care in, especially at a BLS level. Airway, and effective compressions.. that's all is required.

That is part of the problem of EMS. We will discuss and criticize those with problems behind their back, it is easier that way. Hopefully, I made my point and alarmed the poster..hence my point. Brutal, maybe but again better than a subpoena. If one does not know the basics of BLS as such in CPR, then I am concerned of other areas. Yes, I would not want to have rely on such responses from this so called EMS, and truthfully; really, would you want your family to? Again, the recommendation was made of increasing and reviewing education materials, practice and re-practice scenarios to improve skills, and to build team confidence and treatment modalities. As well, I advised to chalk this up to experience, but to critique and improve while doing so. Be hard upon yourself to improve, toughen up to criticism to make positive changes, that is how all successful providers and services have become such.

Yes, I still make mistakes, and thus the reason I still read everyday, practice my skills every week for the past 31 years. I hopefully learn off my mistakes, so I only make it once and not to be a re-occurrence event, as well as have been chastised much harder by higher ups to improve myself. They knew I would take such criticism and improve myself, as I know the poster will as well. Their passion, is what will make them improve.

R/r 911



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[skyemt]

alright, never mind, forget I brought any of this up, I mean I really came here looking for reason for the large volume of vomit and ways to prevent it, not to be lectured on my skills that I and my team members consider profecient, I personally and my other team members think that I handled the situation well

how can you say a situation was handled well, when the outcome was so poor with regard to care rendered?

there is no shame in making mistakes... provided you can learn from them...

i clearly remember a squad night where we did not handle an MVA as well as we should have... rather than sweep it under the rug, or excuse mistakes, we spend the 30 minute ride home from the hospital reviewing and admitting our mistakes, and how we would do it better the next time...
sure enough, we had TWO more mva's that night, and we did a much, much better job of things...

i see too many cases where EMT's want to explain away poor performance, and not take ultimate responsibility... when we respond, it's on us... and regarding the "volly" thing, we are held to the same standards as everyone else, and the public really doesn't care if we are paid or not for what we do.
it is not an excuse for sub-standard care.

again, take the criticisms, go back with the other members, and discuss this call... admit your mistakes, and talk about how you can do it better next time... because there will be a next time, probably sooner than you think.

 

[emtwacker710]

I did take charge on the call, as I said numerous times on theis thread, I inserted an OPA and had the BVM nurse continue bagging with the correct compressions to breath ratio, as I was doing compressions we were suctioning, with both our suction and the suction the nurses had there, it was chunky and we did have to keep cleaning out the tube, also when the BVM nurse kept letting the head go I kept telling her to reposition, this was only the 2nd arrest I have managed myself until the rig got there, all the other arrests I have been on I was in the rig and the other FD responders were there first, yes I will admit I probably should have taken over the BVM for a while but when I got there the nurse doing compressions looked like she was going to drop there so I took over for her.

 

[Ridryder911]

I did take charge on the call, as I said numerous times on theis thread, I inserted an OPA and had the BVM nurse continue bagging with the correct compressions to breath ratio, as I was doing compressions we were suctioning, with both our suction and the suction the nurses had there, it was chunky and we did have to keep cleaning out the tube, also when the BVM nurse kept letting the head go I kept telling her to reposition, this was only the 2nd arrest I have managed myself until the rig got there, all the other arrests I have been on I was in the rig and the other FD responders were there first, yes I will admit I probably should have taken over the BVM for a while but when I got there the nurse doing compressions looked like she was going to drop there so I took over for her.

I apologize to you. I misread the first post then. I do realize vomiting in especially cardiac arrest is very hard to control, especially Ragu and Campbell's chunky style. The best anyone can do is to turn them on their side and sweep out the orpharyngeal area. Even the best suction will not suck up most food debris. Again, the emphasis of an advanced airway is needed on unresponsive patients. Nothing you can do, except sweep and continue.

I still am concerned though on the lack of coordination of codes and the lack of experience of those involved in this event. As you described, you were one of the few trained and yet have little experience. I would not depend upon nursing home nurses to be the most experience or trained in emergency situations. I am surprised they did anything and even notified EMS, most presume they are DNR's and I know of some agencies that prevent nurses from perform any aggressive resuscitative measures.

I still recommend agressive review, and as well multole scenarios. I disagree that you crew should feel that everything was performed adequately. It appeared to be a cluster, orchastration of crews during any situation can be improved with rehearsals and planning.

Good luck,

R/r 911

 

[emtwacker710]

I apologize to you. I misread the first post then. I do realize vomiting in especially cardiac arrest is very hard to control, especially Ragu and Campbell's chunky style. The best anyone can do is to turn them on their side and sweep out the orpharyngeal area. Even the best suction will not suck up most food debris. Again, the emphasis of an advanced airway is needed on unresponsive patients. Nothing you can do, except sweep and continue.

I still am concerned though on the lack of coordination of codes and the lack of experience of those involved in this event. As you described, you were one of the few trained and yet have little experience. I would not depend upon nursing home nurses to be the most experience or trained in emergency situations. I am surprised they did anything and even notified EMS, most presume they are DNR's and I know of some agencies that prevent nurses from perform any aggressive resuscitative measures.

I still recommend agressive review, and as well multole scenarios. I disagree that you crew should feel that everything was performed adequately. It appeared to be a cluster, orchastration of crews during any situation can be improved with rehearsals and planning.

Good luck,

R/r 911

thank-you, as it was only my 2nd arrest that I managed myself I will admit I got tunnel vision (oh no Im not perfect!) sorry had to throw that in there, I did though perform to my abilities and actually talked with the tek yesterday about the call.

 

[MAC4NH]

That sounds like a typical nursing home cardiac arrest around here. Ventilating an untubed patient with a BVM is tricky for anybody who doesn't do it everyday (that includes most EMT's). Many NH nurses are not current with their CPR so don't expect much from them. That patient was probably screwed long before you got there. ALS tubing the patient would have helped but it's highly unlikely that patient had any chance.

In the paleolithic days of the early 90's, the AHA CPR course for healthcare providers required that you use a recording Annie and that you run a one-minute tape. You were allowed 5 compression errors and 2 vetilation errors. The tape had a range of (If I remember right) 500-1000 ccs of air. The upper limit was soon adjusted to 800ccs. If you couldn't limit your vents you didn't get a card. The AHA eliminated the tape requirement a long time ago to speed up the course. Maybe we should back to that system. In the mean time, ventilate only until the chest moves. If the chest doesn't move, you have a problem. Keep the suction handy.

 

[Ridryder911]

That sounds like a typical nursing home cardiac arrest around here. Ventilating an untubed patient with a BVM is tricky for anybody who doesn't do it everyday (that includes most EMT's). Many NH nurses are not current with their CPR so don't expect much from them. That patient was probably screwed long before you got there. ALS tubing the patient would have helped but it's highly unlikely that patient had any chance.

In the paleolithic days of the early 90's, the AHA CPR course for healthcare providers required that you use a recording Annie and that you run a one-minute tape. You were allowed 5 compression errors and 2 vetilation errors. The tape had a range of (If I remember right) 500-1000 ccs of air. The upper limit was soon adjusted to 800ccs. If you couldn't limit your vents you didn't get a card. The AHA eliminated the tape requirement a long time ago to speed up the course. Maybe we should back to that system. In the mean time, ventilate only until the chest moves. If the chest doesn't move, you have a problem. Keep the suction handy.

Actually, that must have been a local requirement. AHA has never required "recordings" since the late 70's and that was for Instructor level only. The recording had to show "stair stack" ventilation and compressions had to be "squared" and level. I agree any additional education would be nice, but folks realistically in the big light CPR does not work, unless in specific conditions.

R/r 911

 

[MAC4NH]

That was the requirement I had to follow at the time. I don't know if this came from the AHA, the regional office or from my training center.

While running the tapes was a pain in the neck for the students and instructors, it did give good feedback and forced students to be aware of their technique.

 

[Jon]

Actually, that must have been a local requirement. AHA has never required "recordings" since the late 70's and that was for Instructor level only. The recording had to show "stair stack" ventilation and compressions had to be "squared" and level. I agree any additional education would be nice, but folks realistically in the big light CPR does not work, unless in specific conditions.

R/r 911

I know my father had to do a perfect strip for his ARC instructor cert in the early 80's... he stopped teaching in the early 90's, and he seems under the impression that they were still doing strips for instructor training... but that was 15 years ago... so who knows.

 

[Ridryder911]

Yeah, instructor level at various times required strips. My first Paramedic course required a perfect strip on the first attempt of testing as well as checking pupils (it was taught at that time to check pupillary response as well) one could make the mannequins pupils constrict or dilate.

Then came the rapid ventilation technique of 'stair step ventilation's" and perfect compressions without any ceasing of ventilation's, one had to have perfect chest wall recoil and perfect compression ration and depth.. as it was recorded.


Ironically, all different techniques was also "scientifically proven" to increase outcomes and to make CPR better.. exactly as the new techniques are claiming now. So you can see why us old timers are skeptical. We have seen several different methods, devices, strategies of CPR and NONE of them have changed outcome significantly. Just like the new methods have already beginning to demonstrate now, a rapid change then a fall as more and more research is done... hmm..

What most of us old timers have surmised is ...

To make it out alive after a cardiac arrest:

BLS has to be started immediately or just a few minutes afterwards (3-4)

Good CPR has to be performed and not interrupted but for a short period of time

ALS has to be initiated within a few minutes..

Now, I totally believe in scientific studies and but also believe in outcome based medicine.. hence seeing what has worked. Codes are pretty much futile.

I predict in the future most will not be worked at all. Unless it is a rapid onset of V-fib or there is immediate resuscitation measures, most will either be worked in the field & then terminated while in the field or never worked; similar to traumatic arrest.

R/r 911

 

[Jon]

One of the old-timers I know jokes that the AHA ECC standards will eventually go back to CPR with raising the arms... like he was doing in the '70's.

Who knows.

 

[Ridryder911]

Yes, they have demonstrated that ventilation's were not as successful as they seemed, but how they obtained these studies are questionable....

 

[Anomalous]

Ironically, all different techniques was also "scientifically proven" to increase outcomes and to make CPR better.. exactly as the new techniques are claiming now. So you can see why us old timers are skeptical. We have seen several different methods, devices, strategies of CPR and NONE of them have changed outcome significantly. Just like the new methods have already beginning to demonstrate now, a rapid change then a fall as more and more research is done... hmm.. R/r 911

I couldn't agree more. CPR sure seemed easier to teach back then.

 

[bassman1490]

i was recently called at sh*t magnet by my friend from the same agency i am in, "emtwacker710" because i had 3 full arrests within my 24h shift

 

[firecoins]

i was recently called at sh*t magnet by my friend from the same agency i am in, "emtwacker710" because i had 3 full arrests within my 24h shift

full arrest? Have you had partial ones?

 

[KEVD18]

full arrest? Have you had partial ones?

beat me to it this time....

 

[bassman1490]

"full cardiac arrests" thats what the dispachers say around here what do you call it?

 

[Airwaygoddess]

Code Blue here.......