Basic CPR Question

[usalsfyre]

*Cough* electricity *cough*

Alright, you win. Throw electricity in my previous statement for shockable rhythms.

Way to spoil making a point

 

[Bullets]

In the Eastern People's Republic, we usually always transport CPR in progress. i think we worked 2 patients who we ended up pronouncing on scene my entire time as an EMT. so cot surfing is pretty much standard and expected, and i usually am the one who ends up riding the rails. If you lower the cot to the right height, its easy to continue to do high quality two handed CPR while surfing. Ive seen my compressions on the monitor. On the other hand, we have a Level II Trauma Center in my town, so our MAX transport time is like 5-7 minutes and thats for extreme cases, average is like 2-3 minutes

 

[18G]

In the Eastern People's Republic, we usually always transport CPR in progress. i think we worked 2 patients who we ended up pronouncing on scene my entire time as an EMT. so cot surfing is pretty much standard and expected, and i usually am the one who ends up riding the rails. If you lower the cot to the right height, its easy to continue to do high quality two handed CPR while surfing. Ive seen my compressions on the monitor. On the other hand, we have a Level II Trauma Center in my town, so our MAX transport time is like 5-7 minutes and thats for extreme cases, average is like 2-3 minutes

CPR is very ineffective during transport I don't care how good you (general you) claim to be. A cardiac arrest is not a "load and go" call type. For the patient to have the best care and best chance of survival all of your efforts (quality CPR, airway, meds) need to be focused onscene, not during transport.

It is well recognized that EMS systems have the same capabilities to resuscitate a cardiac arrest patient as do the Emergency Department's. There are some extenuating circumstances but I would guess over 99% of arrests can be handled the same in the field.

If a ROSC cannot be achieved in the field then it's really time to call Command to cease further efforts. What more is the hospital going to do that hasn't already been done?

"Cot surfing" and all its glory really should be a thing of the past

 

[usafmedic45]

CPR is very ineffective during transport I don't care how good you (general you) claim to be. A cardiac arrest is not a "load and go" call type. For the patient to have the best care and best chance of survival all of your efforts (quality CPR, airway, meds) need to be focused onscene, not during transport.

It is well recognized that EMS systems have the same capabilities to resuscitate a cardiac arrest patient as do the Emergency Department's. There are some extenuating circumstances but I would guess over 99% of arrests can be handled the same in the field.

If a ROSC cannot be achieved in the field then it's really time to call Command to cease further efforts. What more is the hospital going to do that hasn't already been done?

"Cot surfing" and all its glory really should be a thing of the past

About the only exceptions should be a hostile scene (family doesn't want to accept that the person is dead and gets aggressive....been there, seen it) or a profoundly hypothermic patient.

 

[zmedic]

If a ROSC cannot be achieved in the field then it's really time to call Command to cease further efforts. What more is the hospital going to do that hasn't already been done?

"Cot surfing" and all its glory really should be a thing of the past

For asystole sure, but are you really pronouncing PEA/ persistent V-fib in the field? I think those should be transported so the ER can deal with possible causes like electrolyte abnormalities or hypothermia or whatever.

 

[usalsfyre]

For asystole sure, but are you really pronouncing PEA/ persistent V-fib in the field? I think those should be transported so the ER can deal with possible causes like electrolyte abnormalities or hypothermia or whatever.

Outside of hypothermia, which should be easily identifiable, how many cardiac arrest are going to have a good outcome after 20 minutes of being pulseless no matter what the rhythm?

 

[usafmedic45]

For asystole sure, but are you really pronouncing PEA/ persistent V-fib in the field? I think those should be transported so the ER can deal with possible causes like electrolyte abnormalities or hypothermia or whatever.

Show me a study that says you get a better chance of meaningful survival in non-hypothermic PEA and persistent VF transported to the hospital after failure to obtain ROSC. Electrolyte abnormalities can be treated in the field and hypothermia to the point of inducing cardiac arrest is exceedingly uncommon and normally pretty obvious.

 

[medtech421]

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?

If there is an advanced airway in place, then the person doing compressions will then just go fast and hard for 2 minutes while the individual managing airway provides a breath via BVM every 5 seconds. 2 rescuer CPR for an adult does not change the ratio of 30:2 if no advanced airway is in place. Children and infants are the only situations where the ratio changes.

 

[mycrofft]

Ratios change?

Is that the "Chilean School of Chiropractic Medicine" standard, the "Stevie Wonder School of Cardiac Resuscitation By Mail" standard, or what? (Ratios are the same, says the brand new ARC instructor's guide here in my hand, especially the "no breaths" technique, whose ratio is "give thirty compressions, don't stop for a rescue breath, give thirty more compressions...".

Sometimes you will be forced into giving less-than-perfect CPR. Don't plan to; plan how not to do it wrong and what to do if you get caught short.

And as to whether or not a hospital can help more than a top flight paramedic or higher mobile unit, most people undergoing CPR are going to die one way or another. In fact, if they are receiving CPR appropriately, they are already clinically dead, but a majority will go on to fail to "go on" (e.g., be organically dead). Give them the best chance, do it right, and don't fall off (or tip over!!!) a litter or gurney because you get excited and climb on board.

 

[JOgershok]

Is that the "Chilean School of Chiropractic Medicine" standard, the "Stevie Wonder School of Cardiac Resuscitation By Mail" standard, or what? (Ratios are the same, says the brand new ARC instructor's guide here in my hand, especially the "no breaths" technique, whose ratio is "give thirty compressions, don't stop for a rescue breath, give thirty more compressions...".

Sometimes you will be forced into giving less-than-perfect CPR. Don't plan to; plan how not to do it wrong and what to do if you get caught short.

And as to whether or not a hospital can help more than a top flight paramedic or higher mobile unit, most people undergoing CPR are going to die one way or another. In fact, if they are receiving CPR appropriately, they are already clinically dead, but a majority will go on to fail to "go on" (e.g., be organically dead). Give them the best chance, do it right, and don't fall off (or tip over!!!) a litter or gurney because you get excited and climb on board.

2010 Health Care Provider Guidelines Video from AHA:
http://www.facebook.com/video/video.php?v=1304230741322

 

[JOgershok]

THE NEW BLS GUIDELINES FOR 2010 FROM AMERICAN HEART

 

[feldy]

Outside of hypothermia, which should be easily identifiable, how many cardiac arrest are going to have a good outcome after 20 minutes of being pulseless no matter what the rhythm?

this is why we have a 20 min on scene time when working a code. If ROSC is obtained then we transport, if not the we pronouce.

also my agency has the advantage of having the lucas 2 device so when transporting compressions are still effective.

 

[medtech421]

Is that the "Chilean School of Chiropractic Medicine" standard, the "Stevie Wonder School of Cardiac Resuscitation By Mail" standard, or what? (Ratios are the same, says the brand new ARC instructor's guide here in my hand, especially the "no breaths" technique, whose ratio is "give thirty compressions, don't stop for a rescue breath, give thirty more compressions...".

Sorry,yes ratios change. Unless the AHA video I have viewed while teaching is wrong. I mean,what do THEY know. And hands-only CPR is meant for lay people. I left out that standard and discussed advanced airway placement because this forum is meant for professionals.

 

[Handsome Robb]

Sorry,yes ratios change. Unless the AHA video I have viewed while teaching is wrong. I mean,what do THEY know. And hands-only CPR is meant for lay people. I left out that standard and discussed advanced airway placement because this forum is meant for professionals.

Hands only CPR is meant for anyone without proper PPE to provide ventilations. Professional rescuers can still end up being in the right place at the wrong time off duty. Or even on duty, grabbing a bite to eat when the bus is parked in the parking lot and it takes a bit of time for you or your partner to retrieve gear.

And sorry, the ratios haven't changed recently. Still 30:2 with proper PPE....

 

[marineman]

Its not the AHA standard yet but hands only CPR is even making it into ALS protocols now to an extent. My service (100% medic) just changed over to CCR, put a non-rebreather on the patient and place an oral airway then perform continuous compressions immediately. We are still expected to intubate as soon as possible but it is not a first priority. Every time you compress the chest and allow it to recoil there is air exchange within the lungs and typically a single person trying to maintain the open airway while trying to seal the mask and squeeze the bag is not really that effective of a ventilation anyway. Once the tube is placed we follow AHA guidelines. We do have the autopulse which compresses the entire chest more than manual compressions which increases the air movement within the lungs.

 

[medtech421]

Hands only CPR is meant for anyone without proper PPE to provide ventilations. Professional rescuers can still end up being in the right place at the wrong time off duty. Or even on duty, grabbing a bite to eat when the bus is parked in the parking lot and it takes a bit of time for you or your partner to retrieve gear.

And sorry, the ratios haven't changed recently. Still 30:2 with proper PPE....

You are absolutely correct about being in the wrong place at the right time and off duty. If it takes my partner more than 45 seconds to grab a first-in bag out of the truck, I wouldnt be a happy camper, though. The ratio issue seems to be confusing people. It is 30:2 for one and two rescuer CPR on Adults. Child and infant ratios change on 2 rescuer CPR to 15:2 I keep getting people yelling me it never changes. Am I in the only area of the country that treats pediatrics?

 

[medtech421]

Its not the AHA standard yet but hands only CPR is even making it into ALS protocols now to an extent. My service (100% medic) just changed over to CCR, put a non-rebreather on the patient and place an oral airway then perform continuous compressions immediately. We are still expected to intubate as soon as possible but it is not a first priority. Every time you compress the chest and allow it to recoil there is air exchange within the lungs and typically a single person trying to maintain the open airway while trying to seal the mask and squeeze the bag is not really that effective of a ventilation anyway. Once the tube is placed we follow AHA guidelines. We do have the autopulse which compresses the entire chest more than manual compressions which increases the air movement within the lungs.

I was thinking more along lines of BIA such as king or LMA which dont take much longer than an OPA. I dont normally speak in terms of ET tubes because that is not in my scope of practice in SC. I really want to get my hands on an autopulse. I have heard positive and negative about it. Any insights you can share?

 

[mycrofft]

Ah, good old ARC strikes again

Where's my Aricept again? I keep losing it...
The rest of my statement stands, though.
Thanks, JOgershok!