Help for final!!!
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Shishkabob
Forum Chief
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True.
Shishkabob
Forum Chief
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False.
MS Medic
Forum Captain
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Have not had to fool with pure BLS in a while but I would assume you would need to check for respirations and a pulse first.
Here's a similar question that was In my EMT-NR review manual I have.
"While In route to the hospital, the patient goes back into cardiac arrest, your next step should be?"
a.) Tell your partner to stop the ambulance.
b.) begin CPR and proceed to the hospital.
c.) contact medical control for further advice.
d.) analyze the patients rhythm with an AED.
The answer in this case was A. The logic was to have your partner assist In working the patient. Also, keep In mind the ambulance needs to be stopped before the AED can analyze the heart rhythm.
This question takes into account that the PT is in cardiac arrest though, your question just says the cardiac patient is unresponsive, so I would assume you just treat him as an unresponsive pt. What were the options?
"While In route to the hospital, the patient goes back into cardiac arrest, your next step should be?"
a.) Tell your partner to stop the ambulance.
b.) begin CPR and proceed to the hospital.
c.) contact medical control for further advice.
d.) analyze the patients rhythm with an AED.
The answer in this case was A. The logic was to have your partner assist In working the patient. Also, keep In mind the ambulance needs to be stopped before the AED can analyze the heart rhythm.
This question takes into account that the PT is in cardiac arrest though, your question just says the cardiac patient is unresponsive, so I would assume you just treat him as an unresponsive pt. What were the options?
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Actually, the answer that they would like is TRUE. We had a very similar question, and although several sources say that they wouldn't do that, that is the answer that they want you to say.
Shishkabob
Forum Chief
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Trust me, answer is false. Patients go unresponsive all the time, not a reason to delay transport. Otherwise some of our most acute patients would never make it to the er.
If a Pt goes unresponsive the first thing you need to check is your ABC's.
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Unresponsive doesn't mean arrest. Don't delay transport until you have confirmed they are pulseless and apneic.
jjesusfreak01
Forum Deputy Chief
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Yay, that was my instructor's #1 rule. Any visible change in condition --> recheck ABCs.
Sasha
Forum Chief
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Sometimes they go "unresponsive" just to eff with ya. Some of them are very good at it too.
Hal9000
Forum Captain
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Said the PA who began to intubate and was then cursed at.
MedJPavlo
Forum Crew Member
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this made me spit my drink. thank u!! might make it my signature with your permission
Jay
Forum Lieutenant
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That was a common trick question in two ways, for BLS especially, we never attach the AED first, we power it on so that we know if it passes the self test while continuing to the next steps. Second issue, if it's a cardiac arrest why on earth would he have to stop the bus to use an AED... he needs to haul *** while figuring out if an ALS intercept or straight Code-3 to the ER is the right call. My favorite part about these questions is that they intentionally try to throw you off when the answer is really right in front of you.
Jay
Forum Lieutenant
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Did someone say ABC's or is it CAB's now... I don't know if I love or hate the new ECC guidelines for 2010 :glare:
JPINFV
Gadfly
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No such thing as a trick question. The problem is that apparently too many EMT classes only use, or the vast majority of their questions are, first degree questions whereas most of the NREMT questions are second degree clinical vignettes.
Which in real life doesn't work that way. I'm not going to wait for the self check before attaching the pads.
Reasons to stop:
Better compressions when not moving.
Who ever is driving can come back and help with CPR.
Eliminates artifact in the AED.
Jay
Forum Lieutenant
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I agree, the training system is broken in more industries than this one alone.
That is the reason why we use Zoll AED's that have the automated self check as well as pads that can be easily switched to a cardiac monitor carried by ALS. There have been many cases in the past where the batteries were dead and precious time was lost within the first two minutes before the patients remaining O2 starts to dissipate. If you do pads first and then move on to find the unit is dead, you just lost their golden moments where O2 is a minimal issue, this is the reason why the AHA changed the ECC standards for 2010 to CAB because compressions will cycle the remaining air for those 2 minutes. Just a thought. Also, it is state protocol in PA to do it this way as well as recommended by the AHA according to the old and updated ECC guidelines.
I am looking at it like this, the patient needs advanced life support, CPR is only going to sustain them at best, unless an ALS intercept is around the corner and will take over care stopping means time and tissue. I have to agree with you with the AED however that only works with VF/VT and then successful use of the AED reduces rapidly over time, in that case maybe pull over to shock and then continue Code-3 if unsuccessful after the first 4 minutes (2 cycles, 2 shocks). This is not coming off of protocol alone but we learned in ACLS that after the first 10 minutes, the odds of the patient coming around with VT/VF are extremely low even with proper defibrilation and drug therapy, so why lose the golden minutes when advanced care has the best odds of working?
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JPINFV
Gadfly
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Check out the 2010 ECC guidelines. Except for PEA which has immediately reversible causes, the only thing that matters in a cardiac arrest is quality CPR and early defibrilation, which an EMT crew with an AED can provide. This is so important that the AHA is even advocating for termination of arrest policies for both paramedic and EMT crews because, after a short while, it becomes futile to the point that no amount of medications can help. From what the research has shown, ACLS medications do not improve survival to discharge. Additionally, there are benefits to CPR besides buying time. So why waste the first 10 minutes striving towards something that doesn't help and decreasing the effectiveness of the only thing that does?