CPR Pulse?

[itisneverlupus]

Alright, I may be looking into it to much, but its been a while and I have a quick question.

When I was in school it said to cease CPR when the patient regains a pulse. Then I read a while back on a AHA (I think it was) site to keep going regardless if they regain a pulse (ie not even check, just keep pumping), and somewhere today online I read that you do not stop unless the patient is responsive/moves or ALS takes over.

IF the first is true, what generally constitutes a regain of pulse: 6 bpm may not exactly be a great pulse to maintain efficient perfusion (but normal if very cold weather, etc.). Continue anyways?

What if I have no AED on standby (ie I'm in the civilian world, not on shift)?

Thanks, I appreciate the help.

Lupus

 

[Melclin]

I think the confusion might lay in the fact that pulse checks were removed from lay provider CPR.

Not breathing/breathing abnormally = do CPR until an ambulance arrives or they wake up and tell you to stop crushing their chest. Its a nice simple message.

Of course, from a HCP perspective, if you get ROSC then you don't need to continue compressions.

If you have a HR of 6, I doubt you would be generating a pulse and it would simply be an arrest. You wouldn't be able to tell that the HR was 6 without a monitor. If I might hazard the thought, it doesn't sound like you know a great deal about cardiac arrest pathophysiology or management. If I'm wrong, then cool bananas. If I'm right then this is the perfect opportunity to expand your knowledge

The wiki on cardiac arrest seems to give a pretty decent breakdown of some important topics. http://en.wikipedia.org/wiki/Cardiac_arrest

The AHA guidelines are kind of a must read document: http://circ.ahajournals.org/content/122/18_suppl_3.toc

Cardiac Arrest—The Science and Practice of Resuscitation Medicine is a cracker of a book on the topic and about as detailed a resource as you'll find on the topic. I picked up a second hand copy on amazon for next to nothing and its a fantastic read.


What do you mean by "What if I have no AED"? If you have no AED, then you have no AED. Do you mean "What are my options for treating a VF/VT arrest without an AED"? Pre-cordial thumps are an option. Google that and see if its what you're after.

 

[Medic Tim]

If no aed do cpr until one gets there or ems arrives. If you have a defib you do a pulse check if there is a no shock advised or it is not a shockable rhythem but looks organized.

 

[itisneverlupus]

That's what I thought, but I think I just looked into it way to much. I always seem to have these "what if" scenarios. Thanks guys!

 

[Medic Tim]

That's what I thought, but I think I just looked into it way to much. I always seem to have these "what if" scenarios. Thanks guys!

Have you worked a code yet?
The more experience you get the easier it will become.

 

[Anonymous]

I think the confusion might lay in the fact that pulse checks were removed from lay provider CPR.

Not breathing/breathing abnormally = do CPR until an ambulance arrives or they wake up and tell you to stop crushing their chest. Its a nice simple message.

Of course, from a HCP perspective, if you get ROSC then you don't need to continue compressions.

If you have a HR of 6, I doubt you would be generating a pulse and it would simply be an arrest. You wouldn't be able to tell that the HR was 6 without a monitor. If I might hazard the thought, it doesn't sound like you know a great deal about cardiac arrest pathophysiology or management. If I'm wrong, then cool bananas. If I'm right then this is the perfect opportunity to expand your knowledge

The wiki on cardiac arrest seems to give a pretty decent breakdown of some important topics. http://en.wikipedia.org/wiki/Cardiac_arrest

The AHA guidelines are kind of a must read document: http://circ.ahajournals.org/content/122/18_suppl_3.toc

Cardiac Arrest—The Science and Practice of Resuscitation Medicine is a cracker of a book on the topic and about as detailed a resource as you'll find on the topic. I picked up a second hand copy on amazon for next to nothing and its a fantastic read.


What do you mean by "What if I have no AED"? If you have no AED, then you have no AED. Do you mean "What are my options for treating a VF/VT arrest without an AED"? Pre-cordial thumps are an option. Google that and see if its what you're after.

correct me if i am wrong but isn't this an ACLS skill only for witnessed and monitored cardiac arrest?

 

[Medic Tim]

correct me if i am wrong but isn't this an ACLS skill only for witnessed and monitored cardiac arrest?

Used for witnessed arrest where a defib is not available. Usually a Medic skill if it is even on protocols anymore.

 

[mycrofft]

Stopped teaching laypersons to take pulse because it takes so long to decide there is no pulse when you are unaccustomed to palpating one. (Better to teach them to auscultate). Like deciding there is no black cat in a perfectly dark room. Delays compressions.

There are palpable pulse rates with ineffective perfusion, and rates too slow to perfuse. If the pt is unresponsive, you are supposed to continue.

Resuscitation is not like National Geographic Magazine*, throw out the old versions, go with the new.


*(Even though they both occasionally feature the odd bare chest).

 

[Melclin]

correct me if i am wrong but isn't this an ACLS skill only for witnessed and monitored cardiac arrest?

Discussion of things like that here are far less compartmentalised into ALS/BLS, ACLS, CCEMALCLGLSNGKNSEGNKVNAKS. We don't really have the same culture of 'cards', rigid classifications and initialisms, so I couldn't really answer your question. I just suggested it as something he/she may consider pending further research.

 

[Doczilla]

The most recent guidance I heard was 2 mins/5 cycles after ROSC, or if they begin to move and/or go "ouch! ouch! ouch! ouch! ouch!"

Remember a freshly revived heart will not have the work capacity to perfuse the brain adequately, it needs a two min. "primer".

 

[thisgirlisamedic]

Most calls u won't get the ouch, I can't Remember the percent but it is very low of post cardiac arrest actually regaining full gcs, but there are some indicators to look for like movement of arms, eyes etc, but also remember that the likely hood of the pt going back into cardiac arrest is very high, and they have told lay people, and even some first responders to not check.for a pulse, if they don't react to the intial first few compressions just keep going until end shows up, which in my opinion is great, and can help more people recover, but as we all know effective and correct cpr is very rarely done upon the pts onset of cardiac arrest

 

[Doczilla]

Heh... It was a joke

 

[thisgirlisamedic]

Well ya never know lol I've walked in on sheriff's deputies doing cpr on a black guy and they couldn't figure out why he smelled so bad, and when i came in I noticed all the family pics are of a white family, and we have a must transport order if cpr is in progress , I had to make a dozen phone calls to beg not to transport due to advanced decomp.