How long do you do CPR for?

[MMiz]

For all you rural folk, and everyone else, how long have you done CPR for before "calling it"?

If you had an hour commute to the nearest hospital, would you do CPR the entire way?
What about 45 minutes?

Where do you make the judgement call.

The most CPR I've done is on Resue Randy, his wife Annie, and their family of plastic children.

 

[rescuecpt]

I'm not allowed to call it. That's for medical control to do, and only after all standing and md's protocols have been exhausted in the field with no positive effects.

 

[ffemt8978]

For us, we consider a variety of factors in making our decision to transport or call a code.

1) Witnessed/not witnessed arrest
2) Down time
3) Bystander CPR initiated
4) Shock/no shock advised on AED
5) Response time for ALS/Helicopter

If we get three consecutive "No Shock Advised" we will call Med Control and request to call the code.

 

[Jon]

Originally posted by MMiz@Apr 16 2005, 05:57 AM
The most CPR I've done is on Resue Randy, his wife Annie, and their family of plastic children.

You sound like Blue....I mean TTLWKR :lol:

Around here, with extended downtimes, after woring the patient for "a while" usually 10 minutes. ALS calls command and usually ceases efforts...

The official region ALS protocol is:
ABC
CPR
O2
Tube
IV
Asystole 2 or more leads, verify lead placement
Consider causes
Consider Pacing
Epi 1mg q3-5 min
Atropine 1mg q3-5 min, max 0.04 mg/kg
Contact command to consider termination of efforts

So 10-15 minutes in you will hit the call command piont.

The State BLS protocol Says:
BLS Providers can presume death in pulseless, apnic pt's with
Decompisition, Rigor, Dependant Lividity, Decapitation, Unwittnessed arrest of tramatic origin, traumatic arrest in entrapped pt with injuries not compatable with life, incieration
submursion greater than one hour

The state says for a BLS arrest, you don't stop once you start, excet for prehospital DNR, where you call command before stopping.

State says don't work a trauma code unless wittnessed arrest or "signs of life within a few minutes prior to EMS arrivial"

Gotta love the new state protocols - they think up everything.


Jon

 

[emtbuff]

I have assisted in CPR for about 45 min. Both enroute to the hospital and once at the hospital. For all the calls that I have been one they have coded soon to the time we got there or after we had arrived. We check for our pulses signs of mottling or anything else that would contrindicate even trying to do life supporting measures.

 

[devist8me]

When I first started doing this, all codes were taken in. Where I worked at the time, that was sometimes an hour transport time. Now, things like down-time, witnessed/unwitnessed, etc constiutes whether we even start it. And we usually call the doc to have it called after about 20-25 minutes....which is how long it typically takes to start a code, do the skills and get first line drugs on board.

 

[rescuecpt]

We had a code last night, while doing a standby, that took some pretty heroic efforts on many fronts - for nothing. But at least we tried.

Call came in as unconscious but breathing, upgraded to cardiac arrest enroute. There were 3 of us on the ambulance. I took of my sweatshirt on the way (this will come into play later). When we arrived, PD was coming OUT of the house, all red in the face. I look in (first through door) and see PILES and PILES of JUNK. Up to my NECK - 5 foot tall piles of clothes and STUFF EVERYWHERE. I'm 5'5" and in decent shape - I fit through only by putting all the equipment behind me and pulling it through. The woman who greeted us said "we're painting upstairs that's why everything is down here". Painting my *** said my brain to the rest of me. I find my way in to the pt, who is laying face down in a pool of vomit, wedged between a hospital bed and more piles of stuff. I find a place to put my equipment down, the other CC comes in, and we grab the guy and pull with all our might to turn him over and pull him out. He weighed between 270 and 300.

41yo male, history of cardiac problems, mental health problems, and "lots of other health problems" per the parents. "Is he on any medications" I ask. "Yes, lots" is the reply. Apparently he was napping all afternoon, they were supposedly (yeah right) with him, and noticed he stopped breathing. No explanation for how he ended up on the floor. Long story short, I had to straddle him to do CPR, took 3 tries and lots of suctioning to get a tube, shocked 4 times (thought we had fine v-fib), then ran asystole protocol and paced. Ended up getting 3 rounds of epi/atropine in, with some reaction each time but not a prolonged reaction. Got capture, needed an engine co to carry him out. I had to climb over a couch and a table and have a firefighter pick me up and carry me to safety (or did I? hehe).

Pt didn't make it, almost lost my CC - when we got to the hospital he was purple and dripping with sweat - he still had his sweatshirt on - had to take him outside and cool him off. Doc said we had a good tube and did everything right (yay!) The family also came up to us and thanked us before they went inside.

Then we forgot the firefighter we brought with at the hospital. 4 blocks away we realized it and had to go back. Oops.

My partner said never in 15 years has he seen a house that bad. I saw one 1/2 that bad, and thought it was terrible. On the PCR we ended up writing "long on scene time due to necessity of patient extrication from confined space".

 

[Jon]

I live 10 miles from QVC - most all of their stuff ships from west chester.

Once had a BLS call in september at a big elderly lady's house. FDGB, refused transport.

Arrive to find stack of 4 QVC ups boxes on front step. we move boxes, pt. is fallen in back and can't get up and to door - per dispatch. We call for the FD for forcible entry. They arrive. Bldg. Maintnence then lets us in with a passkey. The nice firefighters can't get the door open... the front hall 10-15 feet long, 3 feet wide, has boxes 5' or higher the whole length, both sides. In the "living room" area, there is a 6 foot wide, 4 foot high hill of TRASH that diagonally trasected the room.

Pt. says all the boxes are x-mas gifts. In august / september. Unopened. Pt. can't get to her kitchen. only to front door, TV chair (TV on other side of mound of garbage) and to bedroom. Bed has no sheets.

I said to my preceptor, the ambulance capt., that we should call for social services, or at least get pt's family to the scene before we leave. My concern is this poor old lady, living in rent controlled housing, spending all her money on QVC. All those boxes in the front hall were unopened.

My Capt. overrode me, saying that it's not nice to call social services. Pt refused to have family called to check on her. Fire officer threatend pt. with fire marshal stopping by with ticket book, building maintnence guy said he'd make sure it got dealt with.

Disgusting and sad

 

[Summit]

Basics here cannot terminate without permission.

Wilderness protocols are for 30 minutes with no sign of life are observed or unless continuing CPR endangers the rescuers (exhaustion, dangerous environment, etc).

 

[CodeSurfer]

Anyone ever stop from "exhaustion"? They talked about it in my HCP CPR class but I havent heard of it being done in the field and it wasnt mentioned in my -B class. I can imagine having to take some major slack if you actually did that.

 

[Wingnut]

It was mentioned in my -B class. CPR is to be continued until the pt is revived, called or we are physically exhausted. Our transport time is so short though, I doubt it's ever happened, certainly never heard of it.