Basic CPR Question

[AtlantaEMT]

Also usually one of the most ineffective ways to do compressions while moving. Usually better to straddle the patient and do them that way if possible.

However, it doesn't look as cool, and judging from your avatar, I'm sure that's a factor...:glare:

True, but I'm not jumping on some bloody stabbing victim or someone who looks like they eat MRSA for breakfast. I found it easier to ride the side of a gurney than hop on top of some 300lb fat guy who is already falling off the sides of the stretcher. But that's just me, you do what you like.

 

[usalsfyre]

True, but I'm not jumping on some bloody stabbing victim

There's not a whole lot of point in doing CPR on someone who's blood volume is laying on the ground, but until medics and/or medical directors realize this I agree, probably best not to make a mess of yourself

or someone who looks like they eat MRSA for breakfast.

Not a whole lot of communicable disease that can be diagnosed on "looking like" something. So what does this mean exactly? Nursing home patients? Homeless patients? Do you not have a spare uniform? What your saying is you provide inferior care based on how the patient looks.

I found it easier to ride the side of a gurney than hop on top of some 300lb fat guy who is already falling off the sides of the stretcher. But that's just me, you do what you like.

Easier or impossible? Providing $hitty care because it's easier is called being lazy. I understand this may be impossible on some patients. However, from what it sounded like in your last post you've never TRIED climbing on the gurney, preferring to cot surf because "it looked cool". As far as what I like? I like good care to be provided, convenient and easy for providers not being a major factor in the equation, and "looking cool" not being a factor at all.

 

[Chief Complaint]

Not to thread jack, but ive got a question about CPR as well.

Compressions/ventilations are supposed to be at a ratio of 30:2, and we are also taught that 2 rescuer CPR is done at 15:2. But ive only witnessed CPR done at a 30:2 ratio, with multiple healthcare providers on scene.

What am i missing?

 

[the_negro_puppy]

Not to thread jack, but ive got a question about CPR as well.

Compressions/ventilations are supposed to be at a ratio of 30:2, and we are also taught that 2 rescuer CPR is done at 15:2. But ive only witnessed CPR done at a 30:2 ratio, with multiple healthcare providers on scene.

What am i missing?

It should be 30:2 now for everything (except neonates) the 15:2 was one of the old ways

 

[Chief Complaint]

It should be 30:2 now for everything (except neonates) the 15:2 was one of the old ways

I guess the guidelines im looking at are old, weird, they were given to us this semester. They state that its always 30:2 for adults, but 15:2 for pediatrics (excluding neonates) with 2 providers. Ill be sure to ask in class tomorrow. Thanks for the reply.

 

[mycrofft]

Crikey.

Nipple line on an 86 y/o former stripper? A mastectomy patient? Mid-sternum folks.
CPR fits in a business card: 1/3 the patient's thorax dimension A -> P, eighty times a minute, straight up and down, two breaths per 30 compressions, get help, get an AED, start early, go fast, go deep.
I'd hate to overturn the ambulance litter with myself and the pt on it.

 

[zmedic]

I'd point out that some stretchers have a 400 lb weight limit. If you have a 250lb patient, 02 tank, monitor etc it isn't really appropriate for you as a 200lb provider to jump on top. Lot of liability if the stretcher collapses.

 

[JOgershok]

And if you do not like the side you are forced to be on, you can always spin the patient around to make it more comfortable for you....at least that is what 1-2 students do in every single CPR class I have ever taught...

Now that is funny! How many times have I seen them do it because they were uncomfortable doing it from the left side of the patient or during a switch. @#$% that I am, I made them do it from both sides.

 

[JOgershok]

I'd point out that some stretchers have a 400 lb weight limit. If you have a 250lb patient, 02 tank, monitor etc it isn't really appropriate for you as a 200lb provider to jump on top. Lot of liability if the stretcher collapses.

Who says you have to roll it in the extended position? They do not tip either.

 

[zmedic]

Wait, do you think the weight limit is only in the extended position? Also, they certainly can tip, especially when you have someone riding on top raising the center of gravity.

 

[JOgershok]

There's not a whole lot of point in doing CPR on someone who's blood volume is laying on the ground, but until medics and/or medical directors realize this I agree, probably best not to make a mess of yourself

Pennsylvania's BLS Protocols recognise that CPR on an exsanguinated victim is useless:

CARDIAC ARREST – TRAUMATIC
STATEWIDE BLS PROTOCOL

Criteria:
A. Patient unresponsive, pulseless, and apneic/agonal breaths when acute traumatic injury is the cause of the cardiac arrest.
Exclusion Criteria:
A. If patient meets criteria for DOA (e.g. decapitation, decomposition, rigor mortis in warm environment, etc…) then follow DOA protocol # 322.
B. Patients in cardiac arrest due to overdose, hypothermia, cardiac disease, or other medical conditions when traumatic injuries are not suspected to be the primary reason for cardiac arrest – see Cardiac Arrest protocol # 331.

http://www.portal.state.pa.us/portal/server.pt/document/713751/pa_bls_protocols_effective_11-01-08_pdf

 

[usalsfyre]

I'd point out that some stretchers have a 400 lb weight limit. If you have a 250lb patient, 02 tank, monitor etc it isn't really appropriate for you as a 200lb provider to jump on top. Lot of liability if the stretcher collapses.

Decent point, but I haven't seen a 400lb rated stretcher (other than an ironing board for the aircraft) in a long time. Everything I've seen has been at least 600 in the last 4 years or so.

Wait, do you think the weight limit is only in the extended position? Also, they certainly can tip, especially when you have someone riding on top raising the center of gravity.

Agreed, they certainly can tip. That said MOST of the time if CPR is being performed on the move it's from the ambulance into the hospital (at least here, we try not to put already dead people in the truck), which is generally a smooth, somewhat level surface, and the cot shouldn't be at full height to help offset the elevated center of gravity.

 

[usalsfyre]

Pennsylvania's BLS Protocols recognise that CPR on an exsanguinated victim is useless:

CARDIAC ARREST – TRAUMATIC
STATEWIDE BLS PROTOCOL

Criteria:
A. Patient unresponsive, pulseless, and apneic/agonal breaths when acute traumatic injury is the cause of the cardiac arrest.
Exclusion Criteria:
A. If patient meets criteria for DOA (e.g. decapitation, decomposition, rigor mortis in warm environment, etc&hellip then follow DOA protocol # 322.
B. Patients in cardiac arrest due to overdose, hypothermia, cardiac disease, or other medical conditions when traumatic injuries are not suspected to be the primary reason for cardiac arrest – see Cardiac Arrest protocol # 331.

Glad to see someone recognizes it.

There are a few medical directors who don't trust their staff (some of whom have proven they shouldn't be). By and large though the problem is 1.) field providers who "want to give everyone the best chance" and 2.) EMS management who is concerned with how field determination "looks". Neither one is a valid excuse for tying up resources and risking priority transport on patients who realistically have no chance.

 

[mycrofft]

OOPS 100 a minute!! Sorry!

Either way, I'm worn out by one minute anyway unless the next defib or abalation works better!

Eeenymeeny chilibeenie, the spirits are about to speak...in twenty years or so, professional CPR for cases other than recent poisoning, drowning or electric shock will be optional if there is no AED available.

 

[AtlantaEMT]

Easier or impossible? Providing $hitty care because it's easier is called being lazy. I understand this may be impossible on some patients. However, from what it sounded like in your last post you've never TRIED climbing on the gurney, preferring to cot surf because "it looked cool". As far as what I like? I like good care to be provided, convenient and easy for providers not being a major factor in the equation, and "looking cool" not being a factor at all.

Looking cool was more of a joke but for some reason others took it like it is the main reason I cot surf. I provide the best care possible and is why I've actually had patients call into my work to thank me (even with a paramedic). I work hard and learn everything I can possible (it's why I'm here). I'm often up to 3am on the weekends studying as a biochem major so I can go to med-school. I'm passionate about medicine, to the point I carry a Tabers with me to work and read if I'm not busy with work. But I feel that cot surfing from the ambulance bay to the trauma bay will be decent enough to sustain the patient until they are transferred to the hospital bed.

I've had more than one medic tell me to get on the side (as I was about to hop on), so I assume it works. If not then I'd love to see the study or information that shows that one handed chest compressions are inaffective. Note I said "are inaffective" not "are not as affective". I don't argue that 2 handed chest compressions are better.

 

[usalsfyre]

Looking cool was more of a joke but for some reason others took it like it is the main reason I cot surf.

I'll give you a pass here.

But I feel that cot surfing from the ambulance bay to the trauma bay will be decent enough to sustain the patient until they are transferred to the hospital bed.

Repeat after me. High quality uninterrupted chest compressions ARE. THE. ONLY. THING. THAT. MATTERS. Full stop, end of message. Not "decent enough" chest compressions. Not "kinda ok" chest compressions. Not "we only stopped for a second to drop a tube" chest compressions. Only "high quality, uninterrupted chest compressions". Anything less is not good enough,

I've had more than one medic tell me to get on the side (as I was about to hop on), so I assume it works.

Never assume just because they're a medic they know what the hell they're talking about.

If not then I'd love to see the study or information that shows that one handed chest compressions are inaffective. Note I said "are inaffective" not "are not as affective". I don't argue that 2 handed chest compressions are better.

I can't provide 1 vs 2 hand studies. AHA has a boat full on high quality vs poor quality though. Your not going to convince me one handed CPR on an unstable surface is anything other than poor quality. I've done it a whole bunch, and watched others do it even more. Your giving poor compressions. Just admit it to yourself.

 

[Shishkabob]

Repeat after me. High quality uninterrupted chest compressions ARE. THE. ONLY. THING. THAT. MATTERS.

*Cough* electricity *cough*

 

[abckidsmom]

*Cough* electricity *cough*

But even electricity needs to be augmented with a few compressions.

 

[Shishkabob]

Not if you press "Shock" fast enough!

 

[ffemt8978]

Not if you press "Shock" fast enough!

Sounds like you're confusing your Taser with your Defib.