According to the NR, we're supposed to lift the legs of shock patients. As I understand, the logic is that it tricks the body into thinking that it doesn't have to circulate as much blood, so the heart chills out (more or less). We've been taught, though, that this is illegal in Maine (and I assume elsewhere) because when you lower the legs again the shock pretty much kills them. Has this been your experience?
BLS Shock
- Thread starter AMF
- Start date
Shishkabob
Forum Chief
- 8,264
- 32
- 48
No, I have never heard of it being illegal and would be surprised if it was so. The reason it really isn't done is because the amount of blood it 'returns' to central circulation is minuscule. Not because it will kill someone when you lower their legs.
In reality, if your body is that shocky to begin with, it will have already shunted blood away from the legs. Raising the legs, while technically making it harder for the body to pump blood in to them, the body would overcome that by vasoconstriction if it needed to. Sit down and raise your legs-- You'll see there will be minimal change in blood pressure.
Therefor making the whole move useless in both instances: Either needed but already done, or not needed and your body will reverse what you just did by working harder.
In reality, if your body is that shocky to begin with, it will have already shunted blood away from the legs. Raising the legs, while technically making it harder for the body to pump blood in to them, the body would overcome that by vasoconstriction if it needed to. Sit down and raise your legs-- You'll see there will be minimal change in blood pressure.
Therefor making the whole move useless in both instances: Either needed but already done, or not needed and your body will reverse what you just did by working harder.
JPINFV
Gadfly
- 12,681
- 197
- 63
First off, what is shock? Shock is the inability to properly circulate blood throughout the body. A more appropriate term is "hypoprofusion." It's basically like losing fuel pressure in a car. Sure, the energy (oxygen) content of the fuel is fine, it's just not getting to where it needs to go.
Hypoprofusion is, ultimately, severe hypotension. Blood pressure is determined by 3 major things. Stroke volume (how much is pumped per contraction), heart rate (these two, collectively, determines cardiac output), and systemic vascular resistance. Not enough of either of those will cause hypoprofusion if the other 2 factors are unable to compensate. So if the patient is in heart failure, the heart can only pump so much faster and the resistance can only go so high before cardiogenic shock sets in. In a patient with anaphylactic shock, the arterioles dilate and there's only so much that the heart can do to pump enough blood to keep the pressure up.
In theory, lifting the legs allows gravity to help pull blood through the veins into the body, and ultimately back to the heart (called "venous return"). An increase in venous return increases the end diastolic volume (how much blood is in the ventricle immediately before contraction), which increases the distension of the ventricle. The more distended the ventricle (to a point) the harder it contracts (via a process known as Starling's Law), the more cardiac output, and the higher the blood pressure.
While this all sounds good on paper, it isn't seen under laboratory conditions.
Hypoprofusion is, ultimately, severe hypotension. Blood pressure is determined by 3 major things. Stroke volume (how much is pumped per contraction), heart rate (these two, collectively, determines cardiac output), and systemic vascular resistance. Not enough of either of those will cause hypoprofusion if the other 2 factors are unable to compensate. So if the patient is in heart failure, the heart can only pump so much faster and the resistance can only go so high before cardiogenic shock sets in. In a patient with anaphylactic shock, the arterioles dilate and there's only so much that the heart can do to pump enough blood to keep the pressure up.
In theory, lifting the legs allows gravity to help pull blood through the veins into the body, and ultimately back to the heart (called "venous return"). An increase in venous return increases the end diastolic volume (how much blood is in the ventricle immediately before contraction), which increases the distension of the ventricle. The more distended the ventricle (to a point) the harder it contracts (via a process known as Starling's Law), the more cardiac output, and the higher the blood pressure.
While this all sounds good on paper, it isn't seen under laboratory conditions.
Well it is illegal, and the reasoning is that of the lawmakers, not a medical professional
- 9,736
- 1,174
- 113
Why would they teach it in your class if it was illegal? The one area I could see it being detrimental would be in a patient with increased ICP, seeing as you are trying to keep the ICP down and trendelenburg would theoretically be pushing more blood into the patient's head, but I may be entirely wrong in that thought process.
Last edited by a moderator:
BigPoppa
Forum Crew Member
- 40
- 0
- 6
lampnyter
Forum Captain
- 424
- 0
- 0
They would need to teach is because it is NREMT recognized. Like i had to learn about aspirin but EMTs in CT cant administer it.
JPINFV
Gadfly
- 12,681
- 197
- 63
- 9,736
- 1,174
- 113
Fair enough. But I don't think they would teach a skill that is downright illegal...but i guess as a B administering ASA in CT would be illegal so I answered my own question :wacko:
usafmedic45
Forum Deputy Chief
- 3,796
- 5
- 0
...and also surrender your certification for being that gullible and possessing of other traits that will endanger patients.
rwik123
Forum Asst. Chief
- 718
- 7
- 18
I'm not too knowledgeable on the law, so someone correct me... Would lawmakers delve into such specific and legit medical procedure and out law it? This seems a bit odd. Seems more like a protocol issue than an actual piece of legislature.
Last edited by a moderator:
Wow very professional, maybe we could cut him some slack considering he is a student.
Or maybe thats expecting to much.
usafmedic45
Forum Deputy Chief
- 3,796
- 5
- 0
I think of it as the same kind of professionalism that USMC DIs adhere to when dealing with recruits...minus the screaming. LOL
Apparently, so is expecting our students to have basic reasoning skills and the ability to admit their mistake when corrected. Sorry...I dont think we help ourselves or our patients by cutting the slow, weak and stupid amongst us "some slack". Are you willing to put your life or the life of your child in the hands of someone who passed because their instructors took pity on them? I sure as hell am not.
First of all, I'm not even half-way certified; second of all, by illegal, I mean grounds for revocation; and third of all, on what grounds would I not believe my instructor, my only source of medical knowledge (besides the internet)? Because the law is ridiculous? This from the same state the requires that your shotguns to be blessed in a Christian church and has regions where playing the violin outside is illegal. As far as the National Registry vs State Protocol/Law goes, we are constantly learning contradicting information (Is a fall of the pt's height severe MOI, or does it have to be 3x his or her height or 15ft, whichever is less? Is physical contact a part of Assault? Does code 2 exist?).
usafmedic45
Forum Deputy Chief
- 3,796
- 5
- 0
Prove it. Show us the documentation. If it's you should be able to find it somewhere because that sort of thing has one hell of a paper trail involved with it.
Ever heard of "trust but verify"? Extraordinary claims require extraordinary evidence. I've never heard of a bunch of lawmakers making such a mandate so the logical assumption was that your instructor is either a bumbling moron with his head lodged pretty far up his *** or he was simply messing with you and you didn't pick up on it.
Last edited by a moderator: