Completely uninterupted CPR

MCGLYNN_EMTP

MCGLYNN_EMTP

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So I stumbled upon an article the otherday laying around my station at work. It was on completely uninterupted CPR...even through defib!!
I'm glad to be a paramedic so I can have first responders or basics do the CPR while I push the shock button :P
but in all seriousness...
What do you guys think about this?
 
MCGLYNN_EMTP said:
So I stumbled upon an article the otherday laying around my station at work. It was on completely uninterupted CPR...even through defib!!
I'm glad to be a paramedic so I can have first responders or basics do the CPR while I push the shock button :P
but in all seriousness...
What do you guys think about this?
Click to expand...

Can you post a link to the article??

...even through defib!!
Click to expand...

Maybee thats why ambulances are designed to be able to transport two patients :P
 
Okay, so I asked my instructor, and she didn't know. So I will ask here. If Defib stops the heart, and then the bodies natural pacemakers pick it up, then why is defibbing a healthy person so bad? Like, obviously it would stop their heart, but wouldn't it just restart since it is healthy? Yeah they would be down, but would it kill them?
 
More often than not, defibrillating a healthy person will cause little more than an extremely angry victim. The time defibbibg a healthy person becomes deadly is something called the "r on t phenomonon" where the electrical charge is delivered on the down slope of the t-wave, known as the relative refractory period.

This is when the heart is most susceptable to outside electrical influences. If done on relative refractory period, it sends the heart into vfib, which the hearts pacemaker can't overcome without another electrical charge.



The difference between "defibbing", known as un synchronized cardioversion, and synchronized cardioversion used for vtach with a pulse, is that synched is done on the r wave, thereby missing the r on t.
 
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The compressions themselves create a sort of vacuum to draw air into the lungs and supposbly there is enough oxygen in the lungs for the first 5-10 minutes of the resuscitation so it's effective even in an occluded airway. Your focus in CPR should be perfusion. You can breathe a patient all you want, but if the blood isn't reaching the brain it's futile.

For bystander compression only CPR:
http://circ.ahajournals.org/cgi/content/abstract/105/5/645

http://content.nejm.org/cgi/content/abstract/342/21/1546

For EMS minimally interrupted cardiac resuscitation:
http://jama.ama-assn.org/cgi/content/full/299/10/1158
 
Two people that are emplyed at the service I volunteer at attended a conference on this. It also included about cooling the patient down to like 35 degrees thus putting them into hypothermia and slowing all the bodily functions down and needing less oxygen. The hospital will then slowly warm them (if they are revived). This method has higher success rates than the current CPR guidlines.
 
Yeah, one hospital in my area uses induced hypothermia for cardiac arrest patients. I've heard of a few patients having great outcomes because of this with no neurological deficits.
 
Pudge40 said:
Two people that are emplyed at the service I volunteer at attended a conference on this. It also included about cooling the patient down to like 35 degrees thus putting them into hypothermia and slowing all the bodily functions down and needing less oxygen. The hospital will then slowly warm them (if they are revived). This method has higher success rates than the current CPR guidlines.
Click to expand...

Therapeutic hypothermia is starting to make its way into EMS. However the research really only demonstrates a positive effect in those arrests due to VF. Thus most protocols call for hypothermia only for successful conversion of VF. Currently where I am at, our standing orders are if we convert VF we start ice cold saline wide open with a max of 2L. Personally I have yet to see any major effects (though admittedly I don't see VF all that often).
 
It's rather amazing to me how, back in the day when this paramedic stuff first started (70's) we were pretty sure that all the therapies we were using worked. Between 1985 when I left the field and now I'm reading that a good third of the sure-fire therapies we were using (MAST, CPRespiration, now, even ETI just for STARTERS!) have been debunked if not banned...and I'm not even going near the litany of drug changes!

So next year you can look forward to FD First Response, followed by Paramedic and then the Good Humor Ice Cream truck for a quick freeze!

And then, by 2025, the transport unit will be a Domino's Pizza Hot truck because they since figured cold produces blood clots and heat assures better flow.

Kidding aside, it just tells us about clinging to our ideas and a reminder how this is a dynamic profession that is SERVED by change, not diminished by it.
 
I got it once in a class. The teacher picked up the real units and not the training unit. I was standing at the time and it knocked me to the ground. Both teachers freaked out and I ended up wearing a 12 lead.
 
I suspect the article was referring to mechanical CPR such as the AutoPulse. The AutoPulse does have a feature that allows defib while not interrupting CPR. Of course being mechanical, CPR is non-interrupted during the entire code. You can move the patient down stairs, narrow halls, load in ambulance and all with no interruption.
 
There is that paper referenced above that says CPR is safe during defibrillation, though...

Does anyone currently shock with hands on the chest?
 
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