CPR Whats the point

[Veneficus]

Literally had a ROSC 5 minutes ago.

CPR 30 minutes, shocked v fib 7 times.

On her way to cath lab now.


CPR was started immediately upon arrest.

CPR obviously works...

Strong work my friend.

 

[mycrofft]

Here's a reason for CPR: if I don't tell you not to, I'm going to be on you like paint on wallboard if you DON'T.:angry:

 

[VirginiaEMT]

literally had a rosc 5 minutes ago.

Cpr 30 minutes, shocked v fib 7 times.

On her way to cath lab now.


Cpr was started immediately upon arrest.

Cpr obviously works...

congratulations!!

 

[NYMedic828]

Fingers crossed she makes it out of hospital.

Tried to give her epi/vasopressin pretty sparingly with her age.

Hopefully get a chance to find her tomorrow.

 

[RustyShackleford]

How old was she? Good job regardless of the outcome.

 

[OIFXGunner]

One of our crews worked one not terribly long ago where the patient coded, his wife was there and called 911, and the medic unit made it there within five minutes of his collapse. CPR was started w/ an initial rhythm of VF. The first shock was successful and the rhythm converted to Sinus. He was taken to the closest hospital, hypothermia was induced and he was flown to a facility capable of sustaining the hypothermia protocol. He had coded somewhere around 9AM and by 3PM the he was following commands in the CICU. He was extubated later that evening, and was discharged several days later. A few days after the arrest, one of my mom's old coworkers asked me if I was on the ambulance that day- turns out the patient was her dad. That kind of thing is what makes it all seem worth it to me.

 

[NYMedic828]

How old was she? Good job regardless of the outcome.

Late 70s.

1 liter of cold saline
4mg epi
40 units of vasopressin
300mg amiodarone
7 shocks
35 minutes of CPR

She had a stent placed and today is alive and well in the CCU, extubated I believe.

 

[mycrofft]

OOOraw. ARC or AHA style CPR?

 

[NYMedic828]

OOOraw. ARC or AHA style CPR?

I couldn't tell you the difference but we follow AHA...

Push down on chest, add in some oxygen = CPR last i knew.

 

[Handsome Robb]

Late 70s.

1 liter of cold saline
4mg epi
40 units of vasopressin
300mg amiodarone
7 shocks
35 minutes of CPR

She had a stent placed and today is alive and well in the CCU, extubated I believe.

I bet she's sore. Good on ya though! :beerchug:

Just wondering why no 150 mg second dose of Amio? Going that deep into the algorithm seems like it would have been included as current guidelines stand. Not trying to second guess you whatsoever, just wondering.

Either way congrats and double congrats if she's extubated at talking!

I wish we had a post-ROSC or intra-arrest hypothermia protocol in place, one of my first projects to present to our MD if I clear my TAP if I can get other medics onboard with it. Although I think a big reason we don't have it is area hospitals, except for one, aren't onboard with it which makes it pretty much pointless in the prehospital field if it isn't continued. On second thought I should probably make sure my position is cemented in place before I start bringing up protocol changes.

It's cases like NY's that make CPR worth it. We can't save 'em all but the ones we do save are reason enough.

 

[NYMedic828]

Second dose of amio is a medical control order and I doubt it would of done anything compared to the 7 shocks.

Hard to do CPR and stay on the phone to get orders in a moving vehicle :blush:

 

[MedicalSlick]

This honestly can't be a question.. Your occupation says student.. student of what? construction? Cause it's obviously not medicine.

 

[Veneficus]

This honestly can't be a question.. Your occupation says student.. student of what? construction? Cause it's obviously not medicine.

It is a legit question.

As I said, one that has been asked by some very capable doctors and medical scientists.

In medicine, as in any true profession, we constantly challenge the "norm" in order to make sure we are doing the best we can.

A student who can ask such a question in the face of overwhelming tradition and dogma is a student who is going to do well not only for him/her self, but also for the profession or vocation of healthcare they end up in.

It is the ones who do what they are told without question who you need to watch out for.

 

[Schroeder]

Out here in king county, we have had a 50%+ survival rate of witnessed cardiac arrest. Since we have a tiered system, CPR will be done for quite a bit of time before the medics show up.

There has also been research done (I'll try to find it, but it came up a lot when I was in training) that shows improved defib. results with CPR done for 2 minutes before the first shock. Something along the lines of increasing the blood pressure primed the heart to accept a shock better.

The numbers speak for themselves in my opinion.

 

[Brandon O]

You do it because it works.

 

[Sandog]

Out here in king county, we have had a 50%+ survival rate of witnessed cardiac arrest. Since we have a tiered system, CPR will be done for quite a bit of time before the medics show up.

There has also been research done (I'll try to find it, but it came up a lot when I was in training) that shows improved defib. results with CPR done for 2 minutes before the first shock. Something along the lines of increasing the blood pressure primed the heart to accept a shock better.

The numbers speak for themselves in my opinion.

I would like to see how they came up with those numbers. Was it a 2 patient study?

 

[Christopher]

I would like to see how they came up with those numbers. Was it a 2 patient study?

I wouldn't mock King County's numbers...they lay it all out there (for better or worse).

Adult non-traumatic cardiac arrest, all rhythms, King County is 16.8% survival to discharge intact. Utstein (VF/VT) is 48% in 2009. (n=5958, Jan'01-Dec'09, PubMed)

Pediatric non-traumatic cardiac arrest, all rhythms, King County is 26.9% survival to discharge intact. (n=361, 1980-2009, PubMed)

 

[Brandon O]

Unless there's other research that examines compressions between the first and second shock (I know of none, but that doesn't mean much), I suspect Schroeder is referring to the old literature that suggested patients with long downtimes would benefit from a couple minutes of compressions before attempting to defibrillate ("priming the pump"). Anyone who certified in CPR more recently than the past couple years learned this method. It was instrumental in the 2005 recommendations, but due to conflicting evidence has now been deemphasized post-2010.

 

[Veneficus]

Unless there's other research that examines compressions between the first and second shock (I know of none, but that doesn't mean much), I suspect Schroeder is referring to the old literature that suggested patients with long downtimes would benefit from a couple minutes of compressions before attempting to defibrillate ("priming the pump"). Anyone who certified in CPR more recently than the past couple years learned this method. It was instrumental in the 2005 recommendations, but due to conflicting evidence has now been deemphasized post-2010.

Just my opinion on the matter, but I think it is because whether it works or not is pathology specific.

Without getting into the minute details, if vfib is secondary to an acute MI, "priming the pump" is largely going to be pointless. You won't likely clear coronary artery occlusions with CPR.

However, if the inciting pathology causes shock because of inadequete coronary artery perfusion and the vfib is secondary due to non occlusive inadequete flow, then "priming the pump" seems not only reasonable, but actually required.

If you shock a heart with no blood flowing to it, the only logical outcome is a refractory vfib.

The exact same mechanism as arrest for hemorrhage but with a (mostly)closed circuit such as in septic shock or reduced stroke volume.

 

[NYMedic828]

But considering we have no way of knowing the cause, wouldn't it be the wiser to "prime the pump" anyway?