NEED HELP! scenario question

JeffT said:
check pulse FOR A LONG TIME. At that temp pulse may be one per minute according to the textbook... so it's a trick question... you usually do cpr on someone with no pulse after 10 second check, but in frigid cold, it's another story according to the text books.
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A pulse of 1 per minute or even 10 per minute is no where near enough to sustain life. If you don't feel a pulse after 5-10 seconds you need to start compressions and get the blood moving.

Edit: or what Chaz said
 
JeffT said:
check pulse FOR A LONG TIME. At that temp pulse may be one per minute according to the textbook... so it's a trick question... you usually do cpr on someone with no pulse after 10 second check, but in frigid cold, it's another story according to the text books.
Click to expand...
You're in the cold. You find someone with a pulse rate of 5-10 per minute. You start the CPR you should've done half a minute ago.

^^What they said.^^
 
Gurby said:
For the practical exam yes:
Scene safety, BSI
Direct my partner to stabilize C-spine
Determine responsiveness, etc.

For a written test, check pulse is probably the answer they are looking for.
Click to expand...
i probably should have said that instead of my long response to the original forum info. nicely said Gurby
 
leyvabre said:
Hey everyone, I'm new to this site and EMT class as well. I need some clarification on the following scenario:
25 year old man found unresponsive in the forest by two hikers. He's lying on the ground supine with a liquor bottle nearby. Temp outside is 30F and he's in a tshirt and jeans. After establishing unresponsive what should your next step in patient management be?
A. C spine
B. Open airway
C. Check pulse
D. Measure core body temp

My instructor told me when I'm doubt, follow the sheet. Since the patient is unresponsive, and a cervical injury is unknown would the answer be to take c spine precautions since it is also first on the sheet? Would it be airway because airway is always priority? Would it be pulse because he could possibly be in cardiac arrest? Feedback is much appreciated and any tips on how to better determine treatment in questions like this would be amazing as well. Thank you!
Click to expand...
Check pulse.. If there is no pulse it becomes a CPR situation and c-spine consideration is no longer a priority
 
ABC'S and take it from there. Like they said above multitasking is key.
 
How do you measure core temp anyway as EMT?
I have never seen any BLS unit can do esophageal measurement.
 
DesertMedic66 said:
A pulse of 1 per minute or even 10 per minute is no where near enough to sustain life. If you don't feel a pulse after 5-10 seconds you need to start compressions and get the blood moving.

Edit: or what Chaz said
Click to expand...

I have to disagree with that.
A severely hypothermic patient could have very slow and weak but sustainable pulse(due to low metabolism).
Starting CPR too early could make it into a VF and kills them.

It is actually specific mentioned in WEMT course that both pulse and respiration have to be checked for full one minute by the clock on severe hypothermia before decision of CPR.(Dr. Gordon G. Giesbrecht)
http://www.wemjournal.org/article/S1080-6032(14)00326-3/fulltext#s0420
 
TimRaven said:
I have to disagree with that.
A severely hypothermic patient could have very slow and weak but sustainable pulse(due to low metabolism).
Starting CPR too early could make it into a VF and kills them.

It is actually specific mentioned in WEMT course that both pulse and respiration have to be checked for full one minute by the clock on severe hypothermia before decision of CPR.(Dr. Gordon G. Giesbrecht)
http://www.wemjournal.org/article/S1080-6032(14)00326-3/fulltext#s0420
Click to expand...

"Indication for cardiopulmonary resuscitation
CPR is only indicated in cardiac arrest. CPR is contraindicated if there are signs of life. In a hypothermic patient in the out-of-hospital setting, signs of life may be very difficult to detect. Heart rate can be very slow and pulses can be faint and hard to palpate. The traditional method of checking a pulse by trying to feel the pulse with a finger placed over the presumed location of an artery is limited by cold. Cold fingers have decreased sensitivity to tactile stimuli. Breathing can be very slow and shallow, but may be detectible in the absence of palpable pulses. If cardiac monitoring is not available, the diagnosis of cardiac arrest can be difficult.

Recommendation
Rescuers should make every effort to move the patient to a warm setting, such as a ground or air ambulance or a medical facility where cardiac monitoring is available to guide resuscitation and to start rewarming (1C).

Before starting CPR, feel for a carotid pulse for 1 minute. If there is no detectible pulse after 1 minute, start CPR, including rescue breathing (1C)."

They recommend checking a carotid pulse for 1 minute because the cold environment makes it difficult to palpate a pulse. Nowhere does it say that 5 or 10 BPM is acceptable. If it's actually that low, they aren't perfusing and will need CPR, regardless of their decreased metabolism.
 
Dr. Gordon Giesbrecht (who is a subject expert and wrote above guideline) clearly states even heart rate of 4/min is a contraindication of CPR on severe hypothermic patient during his lecture in 2009. He also condemns common "15 sec look and feel" practice in this situation.

http://remote.wms.org:8083/Overview_Of_Hypothermia/Player.html
(at 42 minutes, or slide 41, unfortunately I don't know if the link works for non-member.)
 
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