Another ACLS Question

[jjesusfreak01]

Somewhat related question. In my county, they practice hard and fast CPR, which is proving to give patients great circulation to the point that some wake up during CPR, some make purposeful movements, and often they will breathe after being completely apneic during cardiac arrest. This happens despite the fact that they remain in a deadly rhythm (read asystole, vtach, vfib, etc).

My question is this. If you (a paramedic) were off duty and came upon an arrest and started CPR, and the patient responded with breathing or better, which stopped when CPR was stopped, would you consider giving a good ol' thump if you knew you weren't going to have a defibrillator anytime soon?

 

[Jay]

I've heard two different things about checking a rhythm. Here's the scenario, after defibrillating vfib/tach do you check the rhythm after? I've had one ACLS instructor tell us to do a quick look right after, and another say immediately start CPR after defibrillating without checking a rhythm. What would you do?

Check out the attached Pulseless Arrest scenario from the ACLS megacodes.

I made it a PDF for you so you can easily download and print it for your review.

You will see in Box 4 for VT/VF to shock and then Resume CPR immediately where it then says to do 5 cycles which should roughly equate to 2 minutes worth of CPR.

Hope this helps... Good luck!!!

 

[Hockey]

After shock delivered resume CPR. I have to agree with Mr Brown on this.

Anyone heard rumors on the new guidelines due this fall? So far I've heard continuous compressions for 6 minutes including thru shock delivery. No attempt at airway control or "breaths" for 6 mins. Basically continuous compressions, shock prn and IV access during the first 6 mins.

Our MD wants to do inservices within a month of the new guidelines being published so we can do them right away. Apparently most places do not adopt them for up to two years after they are published.

Your thoughts?

My thoughts? Well...sure good, but I surely won't be doing compressions when we shock. Letting go for ~3 seconds isn't going to make someone anymore deader

 

[Fox800]

Somewhat related question. In my county, they practice hard and fast CPR, which is proving to give patients great circulation to the point that some wake up during CPR, some make purposeful movements, and often they will breathe after being completely apneic during cardiac arrest. This happens despite the fact that they remain in a deadly rhythm (read asystole, vtach, vfib, etc).

My question is this. If you (a paramedic) were off duty and came upon an arrest and started CPR, and the patient responded with breathing or better, which stopped when CPR was stopped, would you consider giving a good ol' thump if you knew you weren't going to have a defibrillator anytime soon?

Nope. I'd continue CPR, since the pt. is continuing to be pulseless and apneic.

 

[zzyzx]

@Anthony: are you sure you don't want to do a rhythm check before giving a medication? Do you really want to slam 1 mg of epi into someone who has just returned to a perfusing rhythm after a defib, or slamming 300 mg of amiodarone into someone who has convereted into a normal sinus rhythm with a pulse?

Guys, for EMT's using AED's, they should immediately go back to CPR w/o checking pulses after they have shocked. But for us medics, there really is no reason not to check what's on the monitor after you shock. That just seems like common sense to me. No, I don't advocate doing a pulse check after a defib, unless you see an organized rhythm.

 

[Fox800]

@Anthony: are you sure you don't want to do a rhythm check before giving a medication? Do you really want to slam 1 mg of epi into someone who has just returned to a perfusing rhythm after a defib, or slamming 300 mg of amiodarone into someone who has convereted into a normal sinus rhythm with a pulse?

Guys, for EMT's using AED's, they should immediately go back to CPR w/o checking pulses after they have shocked. But for us medics, there really is no reason not to check what's on the monitor after you shock. That just seems like common sense to me. No, I don't advocate doing a pulse check after a defib, unless you see an organized rhythm.

The research has shown that patients will not jump into a perfusing rhythm immediately after defibrillation. That is why we do another 2:00 of CPR following defibrillation, and wait to do a pulse check until that cycle is done. You should wait for that 2:00 rhythm check before you decide which meds to push.