BVM for a COPD patient in cardiac arrest

[KevinEMT]

The struggle has been real. I got my EMT 2 years ago and I'm now in a fire academy that is also an EMT course. Everything has changed regarding o2 to being for patients with SpO2 94% and below only... kind of. But anyway we took a test today that asked about bagging a cardiac arrest patient who went down due to severe COPD emergency. The 3 answers I remember were to aggressively bag them, ventilate at a rate of over 3-5 seconds(adults should be 5-6), and to ventilate at a rate of 20 per minute(it should be 10-12). I might've overthought the question and answers, but wouldn't aggressive ventilations cause distention?

 

[DesertMedic66]

COPD full arrests you bag as normal full arrests, no more and no less.

 

[E tank]

Reading into these questions is a guaranteed way of getting it wrong, but you do find yourself trying to get into the head of the question writer with these...

that said, "aggressive" ventilation (mask or ett?) risks a couple of things in bad COPD'ers that can affect resuscitation. One is dynamic hyperinflation which occurs when, because of the obstructive pathology, the patient's breaths are "stacked" as they are not allowed to fully exhale. This would happen with a faster ventilation rate. You do want to allow for a longer expiratory time with these patients. The lungs can become hyperinflated, raising intrathoracic pressure and impeding or even stopping venous return to the heart. If that's what you mean by "distention", you're correct. The treatment is just taking the bag off of the tube and letting the patient fully exhale.

The other one is rupturing bullae, which would result in tension pneumo, having similar results.

That's all I got.

 

[EpiEMS]

I might've overthought the question and answers, but wouldn't aggressive ventilations cause distention?

The word "aggressive" at the beginning of an answer sounds like a red flag to me. Not to mention that you ought not be "aggressive" with your ventilation - not only for the reason of gastric distension, but also for preventing full exhalation as @E tank said. Just ventilate to chest rise (and let the chest fall), like usual (at 10-12 breaths per minute/once every 5-6 seconds with an advanced airway, or at the usual 30:2 rate without one).

 

[CALEMT]

fire academy that is also an EMT course.

Well this is your first mistake. Fire academies and EMT courses should be separate. The workload is just to much when you mix the two together. Like my pal Desertmedic said their dead, regular ventilations are fine.

 

[STXmedic]

Well this is your first mistake. Fire academies and EMT courses should be separate.

I've got to disagree. This will heavily depend on the individual service. The EMT program for my department's academy (100-120 students/year) has a 95% first time pass rate, and a 100% overall pass rate. Significantly higher than even the next best stand-alone program. I know of another large department that's similar as well.

It's the culture once those students graduate and get out into the field that starts reenforcing the stereotype.

 

[EpiEMS]

Let's not let this thread turn into fire shouldn't be in EMS/fire academies shouldn't teach EMS...
Much as I agree, the point is clear, I think. Ventilate as per usual, OP.

 

[STXmedic]

 

[EpiEMS]

 

[VentMonkey]

Lol, back on topic:

OP, yes you're most likely overthinking it. Plus, you kind of already picked the answer.

At the BLS level I wouldn't overthink this type of stuff, but I will say @E tank made an excellent point about allowing the intubated emphysemic exhalation (I'd be hard pressed not to see even some ALS providers look at this one sideways) to alleviate breath stacking.

In the face of a cardiac arrest as a first responder, regardless of their etiology, or previous history, adequately and properly oxygenating and ventilating is a skill that even ALS providers struggle with, so focus on achieving those two things correctly.