A bone to pick about CPR and how it fits in Primary assessment

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CameronStorer

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So I know CPR, and I know our full assessment.

But what I don't know is how CPR fits into that in terms of the fantasy world that exists within a testing environment.

Isn't assessing the carotid pulse of the patient technically checking circulation before we complete airway and breathing?

You guys know what I mean. "Hey hey, are you okay?" "Call ALS" "Looking for chest rise" "Assessing for the presence of a carotid pulse for five to ten seconds" "Begin compressions while I set up the AED and insert an OPA"

In terms of our BLS protocols, should be be looking for chest rise and checking the carotid pulse of a patient immediately once we see that they are unresponsive?

Is that something that is expected, or would that be a "point off" in a testing environment if we were given a scenario in which a patient was unresponsive?
 
DesertEMT66 said:
https://www.nremt.org/nremt/downloads/E215 Cardiac Arrest AED.pdf

Welcome to the world of testing, where nothing is done how it is in the field. Per the NREMT you check for responsive level, followed by checking for breathing, followed by pulse check, finally followed by CPR.
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But I'm speaking more in terms if the patient is unresponsive but CPR ISN'T indicated. Such as, pt is unresponsive, fast respiration, fast carotid pulse, I'm thinking shock (given that I can see that patients skin as well), but I'm not thinking CPR.

I know on my practical I'm not going to be given such a patient, but if such a case were to present in fantasyland, would I be within the realm of protocol to immediately assess breathing and circulation in an unresponsive patient without properly completing an airway check or a full assessment B and C?
 
CameronStorer said:
But I'm speaking more in terms if the patient is unresponsive but CPR ISN'T indicated. Such as, pt is unresponsive, fast respiration, fast carotid pulse, I'm thinking shock (given that I can see that patients skin as well), but I'm not thinking CPR.

I know on my practical I'm not going to be given such a patient, but if such a case were to present in fantasyland, would I be within the realm of protocol to immediately assess breathing and circulation in an unresponsive patient without properly completing an airway check or a full assessment B and C?
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If CPR isn't indicated then its ABC.

I can't speak for what your protocols are or how your instructors will test you out due to the fact that different places teach and test slightly differently.
 
DesertEMT66 said:
If CPR isn't indicated then its ABC.

I can't speak for what your protocols are or how your instructors will test you out due to the fact that different places teach and test slightly differently.
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My class is all done and I'm just prepping for my real NREMT exam. I'm just wondering if in any unresponsive patient, the EMT-Basic is expected to visually assess the breathing and assess the carotid pulse before continuing with our standard ABCs check. Objectively, that is what I want to know. If you can give me a positive answer you can ignore the rest of my speech below.




Considering the unresponsive patient is discovered to either need CPR, or not need CPR. (I've never had an instructor tell me that their carotid pulse was fast, regular and strong in a CPR scenario) IF that did happen, of course I'd continue on to assess the ABCs but I'd feel like a dumbass for partially checking both before I was even in that part of my assessment.

This special little assessment for CPR that we are taught has always solely revolved around the patient indefinitely needing CPR in our testing environment, and based on other things we have learned about properly assessing the ABCs it seems like we are expected to think that it is only okay to check the carotid pulse and breathing (without completing a full assessment of either systems) of a patient before the airway, upon identifying unresponsiveness, so long as we are magically clairvoyant and positively predict they need CPR.
 
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The way I have to teach for my college, at least, if the patient is unresponsive we check for a pulse. If a pulse is present then we assess airway followed by breathing (CAB). If the patient does not have a pulse then we start compressions and check airway and give 2 breaths after the first 30 compressions are complete.

At my college we are a credited NREMT psychomotor exam location (only offer it to students of the course) so take it for what it's worth.
 
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DesertEMT66 said:
The way I have to teach for my college, at least, if the patient is unresponsive we check for a pulse. If a pulse is present then we assess airway followed by breathing (CAB). If the patient does not have a pulse then we start compressions and check airway and give 2 breaths after the first 30 compressions are complete.

At my college we are a credited NREMT psychomotor exam location (only offer it to students of the course) so take it for what it's worth.
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Alright that just about answers my question, thanks.
 
You can assess your ABCs all at the same time...

"I'm going to palpate a carotid pulse for no longer than 10 seconds while I assess if the patients airway is patent and if their breathing is adequate."
 
Robb said:
You can assess your ABCs all at the same time...

"I'm going to palpate a carotid pulse for no longer than 10 seconds while I assess if the patients airway is patent and if their breathing is adequate."
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Uh huh but I mean in a standard assessment we'd be grabbing BS/LS, RRQ on B and C, CTC, checking for trauma / bleeding giving O2 for AMS etc.

I think my question was answered. I just know that we aren't supposed to start interventions until we fully assess the body system in need of it, but I guess it's just a little different for CPR.
 
Have you taken the new CPR? its been out for a few years now, and they teach CAB instead of ABC. When a patient is unresponsive you go to CAB, which as stated, you can feel for a pulse and look at the chest simultaneously. If they are breathing and have a pulse, you just completed ABC anyway.

You should also go read the thread on abbreviations. My service doesnt allow them and others are moving away from them, so i have no idea what "BS/LS, RRQ on B and C, CTC" means

This is what i get:
BS/LS-Bull**** Lights and Sirens
RRQ on B and C-Registration Request on Bravo and Charlie floors
CTC-Combat Tactical Care
 
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Bullets said:
Have you taken the new CPR? its been out for a few years now, and they teach CAB instead of ABC. When a patient is unresponsive you go to CAB, which as stated, you can feel for a pulse and look at the chest simultaneously. If they are breathing and have a pulse, you just completed ABC anyway.
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Ok this completely answers my question. Yes I have new CPR, I got my CPR card in feb just none of the instructors made it perfectly clear.

This was the most helpful answer though, and cleared up A LOT of confusion.
 
CPR per Dr Kim of "Monday Morning":

379706_329012947218403_855317742_n.jpg


"Do: might live. Not do: die".
 
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As others have said, welcome to the wonderful world of testing. The real world is a little different and, in some ways, a lot easier. Each organization will have their own tweaks on how things are to be done... their way. Many times they want it done just precisely that way so that they can check-off that you successfully demonstrated that psychomotor skill. They're most likely highly aware that is not how things are done in the field.

In the testing environment, I'm going to follow the "script" that is provided so that I get all the required points they desire, in the pattern they desire, so that the proctor can easily check-off those items as I get to them.

Now in the real world, for an unconscious, unresponsive patient, I'm going to do a quick shake/shout while watching for breathing, noting skin signs as I go hands-on for the shake. The shout is likely going to be nearly loud enough to wake the dead. If there's no response, I'm going to start things in motion as I feel for a carotid pulse.

Just getting to that point is only going to take quite literally about 2 seconds. I'm going to do a pulse check for maybe 10 seconds, but that's not going to be wasted time. I'm going to ask for certain tasks to be done while I sort out any airway problems. At any time, I very much could short-circuit things and go straight to CPR, if I feel/determine it's indicated. I'm also going to be looking for any obvious signs as to what might be causing the patient's unresponsiveness. At this point, I've probably used about 12 seconds. The point is that I'm doing things simultaneously that I'm not going to verbalize because that wastes time and doesn't matter to anyone else but be because I'm not being tested. In a testing environment, I will verbalize, and in a sequence so that that proctor knows what I'm thinking about and can follow along and check things off...

So, in testing, just do as the Romans tell you to do...for the realities of life will be a bit different. ;)
 
DesertEMT66 said:
https://www.nremt.org/nremt/downloads/E215 Cardiac Arrest AED.pdf

Welcome to the world of testing, where nothing is done how it is in the field. Per the NREMT you check for responsive level, followed by checking for breathing, followed by pulse check, finally followed by CPR.
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Who says you can't do that all in parallel for NREMT?

The only thing that seems out of place on that form is this:

"Failure to assure that all individuals are clear of patient during rhythm analysis and before delivering shock [verbalizes “All clear” and observes]"

Total waste of time!
 
You are part of a team and have multiple brain cells. Do many things at once.
 
CameronStorer said:
Uh huh but I mean in a standard assessment we'd be grabbing BS/LS, RRQ on B and C, CTC, checking for trauma / bleeding giving O2 for AMS etc.

I think my question was answered. I just know that we aren't supposed to start interventions until we fully assess the body system in need of it, but I guess it's just a little different for CPR.
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A word to the wise. Don't use so many abbreviations. Many new people do it as a way to fit in and show their knowledge/experience (hey I know an abbreviation for this because I've run calls on an ambulance!). Not saying you are doing this, but every time I read anything like that, I just assume that person is new and needs to be shown the right way to document. It does not take a significantly greater amount of time to just write it out.
 
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