No shock advised, now what?

[BigDEMT]

you arrive at a scene of a "man down"

Pt. is not responsive, apnic and you could find no pulse.
You start compressions while your partner sets up the AED. you let the AED diagnose and it says "No shock advise"

what's next?

resume compressions? check pulse? how long?

 

[NomadicMedic]

CPR for another 2 minutes. Analyze again.

 

[Jim37F]

Push hard, push fast...

 

[chaz90]

Assuming this is for the BLS level, as above x2.

/Close thread/

 

[STXmedic]

you arrive at a scene of a "man down"

Pt. is not responsive, apnic and you could find no pulse.
You start compressions while your partner sets up the AED. you let the AED diagnose and it says "No shock advise"

what's next?

Consider field termination.

 

[BigDEMT]

The reason I'm asking is my classmate and I had an argument if should you check for pulse before you resume compressions (his opinion) or you resume compressions for 2 min (5 cycles) and then re-assess (my vote).

other than the textbook answer I'm interested to find out what would you do in the field (BLS level)

 

[cprted]

After the initial pulse check, BLS only performs pulse checks again if there are signs of life. If you wanted, you could assess pulses while the AED is analyzing. But delaying chest compressions to check for a pulse after a no-shock without any other signs of life, not good practice. You'll notice both box 7 and 8 below state "resume CPR immediately."

Finding a pt in arrest, with unknown down time and no bystander CPR, the odds of a single two-minute cycle of chest compressions achieving ROSC are pretty much nill.

 

[DesertMedic66]

Slam that energy drink and protein shake because it's going to be a workout for you guys/gals.

 

[Tigger]

Hands over the chest while the AED is doing it's thing and then right back to compressions as soon as that eery "it is now safe to touch the patient" is heard.

 

[ShearFish]

Make them ribs mushy.

Odd question, does anyone else have the monitor with the female voice that screams, "Deeper" or "Faster" if you are doing compressions wrong? I find it hard to stifle a laugh every time I hear that. Or maybe I'm just that twisted.

 

[PotatoMedic]

Make them ribs mushy.

Odd question, does anyone else have the monitor with the female voice that screams, "Deeper" or "Faster" if you are doing compressions wrong? I find it hard to stifle a laugh every time I hear that. Or maybe I'm just that twisted.

All I can imagine now is someone with CPR pads on their pelvis...

 

[Brandon O]

The confusion here may be that some sources suggest, if you've been working the code (not the initial shock like this) and get a "no shock advised," you should check the pulse because you might've got a rhythm back with the last shock. But what I teach and what's most consistent with the guidelines (and data) is to keep pushing and shocking until there's some kind of overt signs of life or reperfusion (I would accept pinking of the skin). Otherwise in an asystole arrest you're going to be stopping for pulse checks every 2 minutes, which is absolutely not okay.

 

[JPINFV]

The confusion here may be that some sources suggest, if you've been working the code (not the initial shock like this) and get a "no shock advised," you should check the pulse because you might've got a rhythm back with the last shock. But what I teach and what's most consistent with the guidelines (and data) is to keep pushing and shocking until there's some kind of overt signs of life or reperfusion (I would accept pinking of the skin). Otherwise in an asystole arrest you're going to be stopping for pulse checks every 2 minutes, which is absolutely not okay.

If they're BLS (or ortho sx), they might not know if it's asystole.

 

[Brandon O]

Well, exactly. Although if you did find no pulse and it was No Shock Advised I suppose you could play odds.

 

[Sunburn]

You won't get pinking of the skin if it's 2 am and 5 degrees outside. 2 min intervals are there for a reason and you should definitely stick to them.

 

[RedAirplane]

If I recall correctly, checking pulse instead of resuming compressions is critical fail criteria.

 

[JPINFV]

Well, exactly. Although if you did find no pulse and it was No Shock Advised I suppose you could play odds.

...PEA...

...also if the patient reaches asystole, then it really doesn't matter much since asystole is a relatively stable rhythm.

 

[Brandon O]

All rather moot unless the BLS crew is sitting around placing bets on the rhythm...

Actually, I shouldn't say that, I suppose you could argue a PEA rhythm might provide additional motivation to search for correctable causes. But I'm insane and even I would be a little skeptical of a Basic huddling on the floor trying to diagnose PEA by heart tones or something. Get dat history instead.

 

[Gurby]

Calling for ALS should be something that happens pretty shortly after you get on scene.

The reason I'm asking is my classmate and I had an argument if should you check for pulse before you resume compressions (his opinion) or you resume compressions for 2 min (5 cycles) and then re-assess (my vote).

other than the textbook answer I'm interested to find out what would you do in the field (BLS level)

You are right here - jump right back into compressions. If you do get pulses back after a shock and their heart is now beating, a bit more CPR isn't going to hurt them - in fact, it might even help. The protocol in my state for symptomatic bradycardia in peds is to do CPR if their heart rate is under 60 - just as an example of how you don't need to worry about doing CPR on a beating heart.

 

[JeffT]

http://emtlife.com/threads/shockable-rhythms.13976/