Code Scenarios?

[Nervegas]

I asked him if he was going to stop, but apparently its unwritten practice to not stop compressions... or even switch out.

Don't do this, as the others have said, switch out every 2-3 minutes to maintain good compressions.

...though they were worried they had misplaced the tube in his stomach. At some point, I remember seeing vomit, and suctioning his mouth... but I can't remember if that was pre-tube or after-tube.

You can't "misplace the tube" in the stomach with a BIAD like the King or Combi-tube, with the combi tube, it just depends on which lumen is the one putting air in the stomach and which is not (based on if the tip of the tube went in the esophagus or the trachea), if you had good chest rise and lung sounds with no epigastric sounds then you were using the correct lumen. You can get vomitus to come up the other lumen though, if the tip ended up in the esophagus, which it does most of the time...

So now, I'm just waiting for the next code to come through. If I can learn a thing or two before it comes, perhaps I won't make a painful goof on a call.

Experience, it will come with time, I remember my first code's, it gets better with time, trust me.

 

[jjesusfreak01]

Personally, I think I can probably do good CPR for 10 minutes with a patient on the ground (though I would be wiped afterwards), in the back of a truck or in an ER I get tired after a few minutes. You have to switch out.

 

[NomadicMedic]

Personally, I think I can probably do good CPR for 10 minutes with a patient on the ground (though I would be wiped afterwards), in the back of a truck or in an ER I get tired after a few minutes. You have to switch out.

I think you'd be surprised. Almost nobody can do 10 minutes of good, high performance CPR.

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[Milla3P]

My real question isn't about the protocols, or trying to address all the "what if's". Its about what you've done that worked well, and what didn't work so well.

This.

My fiancé was D/P to local psych eval office {sigh} for syncope. ATF an obese 40-something y/o female with her torso UNDER a SUV pulse less and apnic. CPR on scene, monitor- V-Tach, shock x 1 -> PEA, sinus brady -> CPR, BLS airway, recheck - sinus brady with pulse, 5 cycle CPR, sinus tach with pulse -> NSR @ 80. Failed IO access. Full code save w/o access, tubes or drugs.

3 weeks later pt walked in with zero deficits and said thanks and gave out high fives.

Recent Hx of gastric bypass, electrolyte imbalance caused sudden cardiac arrest.

Anyone else got anything ON topic?

Some studies show that hands only CPR with a NRB on high flow is enough airway, others say you can fully defib WHILE doing compressions if you have gloves on (fat chance I'll be doing it).

These are ALL interesting points, but none of them address OPs question.

 

[NomadicMedic]

I don't get what you're saying... I think we addressed the issues.

The OP asked what works well in a code.

First and foremost, continuous high performance chest compressions with providers changed every two minutes works. It's the best thing you can do in a "code scenario".

If you're attempting to ventilate the patient, actually getting air in works. Anything else in that area is a fail.

The OP also seemed confused about how a BIAD is placed, and I believe that was addressed as well.

Did we miss anything?

 

[Milla3P]

I don't think much was missed, if he asked for 2 pages of arguing over AHA guidelines and nit picking the foggy recollection of a ride along student from 6 months ago.

But the part where he specifically asked about scenarios from your, mine and everybody else's personal experiences. Yeah there might of been a little something omitted from the conversation.

 

[STXmedic]

I think you'd be surprised. Almost nobody can do 10 minutes of good, high performance CPR.

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Seconded! I'm in pretty darn good shape, and I'd be lucky to get two rounds of high quality CPR in. h34r:

 

[NomadicMedic]

Seconded! I'm in pretty darn good shape, and I'd be lucky to get two rounds of high quality CPR in. h34r:

Amen. If I have to do CPR before I get the LUCAS on, I'm ready for a nap!

 

[Handsome Robb]

I don't think much was missed, if he asked for 2 pages of arguing over AHA guidelines and nit picking the foggy recollection of a ride along student from 6 months ago.

But the part where he specifically asked about scenarios from your, mine and everybody else's personal experiences. Yeah there might of been a little something omitted from the conversation.

You need to chill. Don't come out of the woodwork and start throwing stones, it's frowned upon. Secondly I don't think I've ever heard someone refer to PEA as PEA, sinus brady, but thats just me. Usually it's just slow PEA, please correct me if I'm wrong.

Where is the nit picking? The OP asked for opinions and we gave them.

Cool your fiance got a save, props to her. NRB use during an arrest is generally referred to as CCR not CPR. Cardiocerebral Resuscitation vs. Cardiopulmonary Resuscitation. Although CCR is a umbrellaed under CPR. Fine, I'll admit that was nit picky

I personally didn't see any post advocating the need for an advanced airway in an arrest although it is preferred expecially since end tidal is more readily available off of a tube when compared to access to sidestream end tidal. If you're getting get compliance with a BLS airway then that's fine, just be prepared for gastric distention and vomiting which could occlude an airway that was originally patent with BLS measures.

If you want to talk studies, there are studies out there that show no positive effect on outcome to discharge from the use of Epi in an arrest setting. Why do we still use it?

Edit: on the subject of effective CPR what are everyone's thoughts on the qCPR puck with the Philips MRx?

 

[mycrofft]

Usual random shots, er, thoughts

Our FD's medical controller has crunched the numbers, and with all other factors either remaining the same or a little worse due to manning losses, a higher percentage of CPR cases are resulting in saves since 2010 protocols instituted. I'm not aware of the airway situation but they were never super-hot to trot for intubations or other invasive airways.
Ninety solid minutes of quality compressions? Flag toss. I once did 49 back when it was 60/min, I was in good shape then, and I couldn't hold a coffee cup afterwards.
OP, my personal biases are these: many saves were going to resuscitate with little help, as long as it was timely and correct. Stuff like OD's, suffocations, electrocution, or a transient or paroxysmal arrhythmia, or sometimes they weren't clinically dead but a bystander prematurely started CPR, resulting in a "save".
The reason "a hospital can't do any better for you" is that most clinically dead patients are going to organically die anyway, and the hospital depends upon receiving at least an organically live person to work on; they can do more, but if it isn't done right and "right now" in the field, then you might as well bring them a spiral cut ham with the fixings. If prehospital care is equal to a hospital's, then after you saved the pt (what, field resusc isn't making them stand up and dance?) you could just drop them off at a care facility for a week of monitored rest.