cardiac arrest tips and tricks you have learned along the way...?

[usalsfyre]

Standard of care? Standard of care?!? This! Is! EMS!

ARRRRRRRRRRRHHHHHHHH

When did Gary Ludwig grow a beard?!?

h34r:

 

[Melclin]

Standard of care? Standard of care?!? This! Is! EMS!

ARRRRRRRRRRRHHHHHHHH

HAHAHAHA. Launch the ROFLcopters.

 

[Sasha]

Standard of care? Standard of care?!? This! Is! EMS!

ARRRRRRRRRRRHHHHHHHH

Damn I thought it was Sparta.

 

[BandageBrigade]

You can equip several supervisors vehicles with glidescopes (est at 10,000 each) but cannot get waveform cap or even cpap? Somethings not adding up. IMO glidescopes have no place prehospital. There are much cheaper more portable options that require no setup time.

 

[Too Old To Work]

When did Gary Ludwig grow a beard?!?

h34r:

I don't care who you are, that's funny right there!

 

[Too Old To Work]

Standard of Care.

Out of curiosity, do you know who sets standard of care and how it is set?

As to waveform capnography, it's a great tool. We use it for every intubation, but we use it a lot more for conscious patients. It's very useful for monitoring sedated patients, such as those to whom we give Versed or Ativan. That includes seizure patients, agitated patients, people we are going to cardiovert, and well anyone that we sedate. We also use it for all respiratory distress patients. I haven't done it, but someone I know uses it for SVT patients to see if they are hypoperfusing. His theory being that once the ETCO2 falls below 37 or so, the patient is probably not perfusing well enough to ventilate at the cellular level. Sounds good in theory, but I haven't seen any science to back that up.

What's interesting is that only one of the hospitals I transport to has wavform capnography in the ED. I find that incomprehensible. They do have colometric devices, but they can only use them for ETT placement confirmation.

Of course it's been well known for over 15 years that quantitative capnography is a good predictor of ROSC. I seem to remember Roger White MD, from the Mayo Clinic talking about this at EMS Today in 1995 or '96. It only took EMS about 10 years to catch up on that.

 

[usalsfyre]

You can equip several supervisors vehicles with glidescopes (est at 10,000 each) but cannot get waveform cap or even cpap? Somethings not adding up.

I agree with this, but...

IMO glidescopes have no place prehospital. There are much cheaper more portable options that require no setup time.

What setup are you talking about, and how often do you not have a few minutes prior to an intubation? Not to mention what "cheaper and more portable" options are out there that provide the same view, ease and comfort of use? Not the Airtraq and certainly not that stupid blade with what looked like a telescope in it.

 

[jwk]

You can equip several supervisors vehicles with glidescopes (est at 10,000 each) but cannot get waveform cap or even cpap? Somethings not adding up. IMO glidescopes have no place prehospital. There are much cheaper more portable options that require no setup time.

What setup time? More time than hooking a laryngoscope blade on a handle?

I'm not sure how portable you want, but our battery-powered ones are pretty small and light.

I haven't found anything cheaper that I like better than a GlideScope - not even close.

 

[BandageBrigade]

Setup - it has quite awhile since I have used a glidescope, but the service I was on that had it kept it in this big bulky pelican case(first mistake) with all its supplies. If I remember correctly, there was a blade cover to take off, and a write to screw on/connect, as well as waiting for the screen to load. I can concede that in reality its probably not much longer than a setup for regular intubation takes.
Airtrach (traq? Cant remember how it was spelled). Did not like those at all. Cheap however.
Do you remember what the 'telescope' ones were called? We had a demo for them but did not even bother with a trial use. We have been trialing the mcgrath system; so far everyone seems impressed with the results. We will see how much cheaper than the glidescope it is. It may just be a personal preference, but I like that the screen is attached, with no seperate screen to have to mount somewhere, or find a convenient place to set with a good view while intubating. It being smaller and all one piece is what makes it more 'portable'

 

[quewiwi]

You can equip several supervisors vehicles with glidescopes (est at 10,000 each) but cannot get waveform cap or even cpap? Somethings not adding up. IMO glidescopes have no place prehospital. There are much cheaper more portable options that require no setup time.

I think you got mine and RESTECH's comments mixed up. We don't carry glidescopes on our units...or cpap or capnography.

And thanks for the tips Usalsfyre!

...

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[BandageBrigade]

You are correct! My mistake.

 

[usafmedic45]

Apnea is a contraindication to nasal intubation. You need the patient to take a breath to pass the tube. when the pt inhales you advance the tube. You keep doing this until the tube is in place.

I bet you also believe you have to have a laryngoscope to place an ETT orally as well.

the text book answer is: in between attempts you are supposed to ventilate your pt. it is impossible to properly vent your pt with an ET tube hanging out. so you are supposed to remove the missed intubation that ended up in the esophagus.

No offense, but do you actually run this crap through your head first before letting it out or is more of an unconscious stream of drivel you have no control over? Yeah, you can ventilate with the tube "hanging out". You push it over to the corner of the mouth the same way you would do if the person had an NG tube in before they coded.

It would be difficult to create a mask seal with a tube sticking out of their nose or mouth still.

Point taken, but there is a difference between 'difficult' and 'impossible'. The more practical reasons for removing the ETT from the first attempt is to have it available for use and to also not clutter up the oropharynx should you decide to try laryngoscopy again.

True, many may whince because of the lack of it not being sterile ... so be it. Especially in conditions where ambient noise such as extrication and sirens makes it difficult to hear.

I always like to point out that the lungs aren't anymore sterile than the inside of one's rectum.

 

[systemet]

I always like to point out that the lungs aren't anymore sterile than the inside of one's rectum.

I think you misspoke here. The pharyx is part of the GI tract, and full of bacteria, not least of all because of the amount of sugar we consume.

But the lower airways are virtually sterile in the healthy individual. I'm sure you're aware of this.

 

[usafmedic45]

But the lower airways are virtually sterile in the healthy individual. I'm sure you're aware of this.

No orifice (read as "cavity with communication to the outside" before someone tries to point out the knee joint space) is even virtually sterile. Don't confuse "absence of clinically significant levels of pathogenic organisms" with "sterile". Remember that most chronic bronchitis is simply an opportunistic infection of normally present flora going after tissues whose defenses have been lessened by whatever issue is at hand (smoking being the obvious and most common one).

The fact that we aren't putting something into the lower airways (at least intentionally...some have differing opinions of 'upper' vs 'lower' airways; I use the carina as the dividing line for the sake of a ready reference point) and have to go through the frighteningly polluted cesspool that is the average human mouth, notwithstanding of course.

 

[JPINFV]

I see your clarification and raise you the bladder and ureters...

I'd also raise you the peritoneal cavity in females.

 

[usafmedic45]

I see your clarification and raise you the bladder and ureters...

*facepalm* I figured one of the med students would find an actual exception to my statement.

 

[JPINFV]

*facepalm* I figured one of the med students would find an actual exception to my statement.

I'm more proud of thinking of the peritoneal cavity in females... Fallopian tube openings and all that jazz...

 

[legion1202]

I don't have any real tips yet since i`m still a medic student. But as a emt i`ve been on a few codes. I`ve learned fast that organization is key to prevent that cluster F***. Also someone needs to have command. The last code I was on had 5 medics telling everyone what to do and as the only EMT I didn't know who to listen too.

The best code I was on was with BSO fire rescue as a emt student at st 37. It was 2 medics and my self as a emt student with no back up.. It wasnt a save but we did everything we needed to do imo with just 3 guys. My buddy and his partner had there stuff together that day..

 

[johnrsemt]

I totally agree with the not transporting corpses: I like the area's that won't do it, UNLESS it is an infant. What makes an infant arrest different? Most of them are SIDS and have been dead longer than most adult arrests.

I won't transport dead people from here because we have a 45 min transport time from gate, and up to 2-3 hours to the gate. And no helicopter service will transport an arrest unless they have ROSC and has a pulse when they land.

 

[johnrsemt]

But I do have coworkers here that think I am a bad medic because I don't want to transport dead people. Good thing the ones that think that are Basics; and I don't have to listen to them.