Patients that go unconscious or back into Cardiac Arrest while en route to Hospital..

Jim37F said:
In theory, a pt who's bad enough off to where you honestly believe they have such a high risk of coding during transport that you want to place defibrillator pads preemptively should never be going via BLS anyway. Yes I do have an AED relatively handy (it sits in the bulkhead compartment next to the side door) (We carry the Zoll AED Plus, a commercial model not significantly different than what the general public has access to, just put it on, press a button and let it do its thing, if it does not detect V-Fib/V-Tach it will not deliver a shock no matter how much I want it to)

Since not every patient that goes into SCA is a candidate for defib, I'd argue immediate chest compressions are more vital. Have your partner immediately pull over, radio for ALS, then head to the back to apply the AED. Hopefully their in a shockable rhythm, but if not then they needed those compressions more than the AED...
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Maybe...
http://www.jems.com/articles/print/...ads-nurse-to-shock-concious-boy-with-aed.html
 
Time and skill level of your unit are a big factor in this question.If you're a BLS unit 5 min or less from an ER one rescuer CPR/AED and diesel.If you say 10 mins out I would pull over and alternate compressions with your partner till an ALS unit arrived. If you were on an ALS unit 5 min or less I would still go with CPR/difib and diesel. Being a true 5 min or less. 10 mins out on an ALS unit pull over and and work the code per ACLS guidelines until you had ROSC or 20min with out a pulse. Here is how you justify this,If you're 5 mins or less out BLS or ALS quality CPR is better than delaying transport to the ER to either A.wait for an ALS unit or B. Spend another 15 min on the side of the road initiating full ACLS care. I'm not saying I wouldn't place the fast patches ect but intubation not so much.If they have a line if its handy give them an initial epi. Over 10 mins you're no going to be able to provide quality compressions,this is not an option but fact proven by the AHA.Not only would that be less beneficial to the patient but a lawyer would rip you apart if it went to court. AHA has time after time emphasized high quality compressions and that is the focus of a situation such as this.When it all comes down to it,you can intubate,start IVs and push drugs all you want.But if blood isn't circulating it's all useless. I'm just glad the ground service I work for has LUCAS's lol.Also just FYI compressions are where it's at,I remember back in the 5:1 days I didn't get ROSC on half the number of patients I do now.
 
LocNar said:
Precordial thump.
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+1 on this! I was going to write the same thing. Witnessed arrest (witnessed by me, that is) and my first move is always going to be a precordial thump. If that doesn't work, on to the algorithm.

Or in other words, give em the shocker
 
Witnessed arrest en-route and more than 2-3 minutes out from ER. Pull over, apply AED\analyze, work them as usual. Call for a medic and manpower.

Witnessed arrest en-route and less than 2-3 minutes out from ER. Work them with focus on best CPR possible and AED. If manpower and time permits, attempt to get a King in them. By the time we pull over and wait for a medic, we could have already had them to the ER.

Unconscious: Check my ABCs, call for ALS, get a set of vitals, titrate 02 to SPo2 of 94% - 96% if hypoxic, run a 12-lead and print a strip for incoming ALS if they want it, check sugar, and upgrade to lights and sirens if not already running priority. May consider calling ER to give initial report, depending on the situation.
 
I agree with those who say relax, pull over, and work the code like a day at the office. In fact we now train for it because our own data showed that 10-15% of our cardiac arrest patient's re-arrested en route to the hospital. For witnessed VF/VT arrests in particular, when you get ROSC, set the VF/VT alarm (we've had 1-2 minutes of unrecognized VF while moving down the sidewalk). Now when we do simulations, we have our crews load the patient for transport and we have the patient re-arrest. They verbalize that they pull over, start compressions, charge the capacitor, shock while minimizing perishock pause, and so on. The worst way you can treat this is "high flow diesel." Those patients die when we lose our cool.
 
Gordon Miller said:
Time and skill level of your unit are a big factor in this question.If you're a BLS unit 5 min or less from an ER one rescuer CPR/AED and diesel.If you say 10 mins out I would pull over and alternate compressions with your partner till an ALS unit arrived. If you were on an ALS unit 5 min or less I would still go with CPR/difib and diesel. Being a true 5 min or less. 10 mins out on an ALS unit pull over and and work the code per ACLS guidelines until you had ROSC or 20min with out a pulse. Here is how you justify this,If you're 5 mins or less out BLS or ALS quality CPR is better than delaying transport to the ER to either A.wait for an ALS unit or B. Spend another 15 min on the side of the road initiating full ACLS care. I'm not saying I wouldn't place the fast patches ect but intubation not so much.If they have a line if its handy give them an initial epi. Over 10 mins you're no going to be able to provide quality compressions,this is not an option but fact proven by the AHA.Not only would that be less beneficial to the patient but a lawyer would rip you apart if it went to court. AHA has time after time emphasized high quality compressions and that is the focus of a situation such as this.When it all comes down to it,you can intubate,start IVs and push drugs all you want.But if blood isn't circulating it's all useless. I'm just glad the ground service I work for has LUCAS's lol.Also just FYI compressions are where it's at,I remember back in the 5:1 days I didn't get ROSC on half the number of patients I do now.
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Five minutes is a long time to be doing crappy CPR...
 
Serious question : do you work them in the back of the ambulance, or do you take the gurney out and put them on the ground?
 
I haven't seen one in ages. Most of my arrests wind up on a board if I'm transporting them. (Usually I work them in the hosue and call it...)

But sure, for the sake of argument, shove something hard underneath. :)
 
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cruiseforever said:
Does anyone still use a CPR board? I have not seen one used in a long time.
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We have these weird looking plastic foldable boards on the bottom of our hopsital strecthers that nobody ever uses. I can't figure out if it is meant to be a CPR board or help/facilitate patient transfer. Nevertheless, no one ever uses them.
 
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