Pierce County and CPR

Melclin

Melclin

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I read an article in a local journal by an Australian paramedic about a "study tour" she took to some American EMS outifts. She spent a while with the Pierce county FD (I think). In it she mentioned their CPR technique.

"...continuing CPR whilst charging before defibrillation and only stopping as the shock button is pressed....There is no checking for pulses and CPR is not stopped for the benefit of putting in an airway or stopping in order to have a 30:2 compression to breaths ratio, breaths are provided in between compressions.
Click to expand...

Perhaps because it was so poorly written, the article confused me a little. Could anyone point me in the direction of the Piece county protocols or answer some Q's? Anyone here from pierce county? Anyone run their show similarly?

-Could someone explain to me more clearly the logistics of the pulse/rhythm checks.

-Is safety adversely affected by having less time in between touching and shocking pt?

-how exactly do you ventilate in between compressions? You'd have a fraction of second at most.

In general I like this move towards reducing any time spent not bouncing on chests. We're awefully sloppy about it here and no one at uni seems to mind that we frequently take up to 30 seconds to defib pts after we cease compressions which is ridiculous. I'd appreciate any articles, links, thoughts or discussion on how you streamline your process.
 
I can't speak for the fine people of Pierce County, but since the AHA/ARC standards are pretty much used nationwide...

You can't give breaths while compressions are going unless the patient has been tubed - you'll push the air right back out. But you do 30 compressions, give 2 breaths, then resume with 30 more compressions, etc. If the patient has been tubed, you can compress and ventilate at the same time.

Generally, you do a 2 minute CPR cycle while the AED is prepared. Analyize, shock if indicated, do another full cycle of CPR, reanalyize. Rinse, lather, repeat. Probably, if you're in EMS, you're putting the patient on the stretcher/board/whatever and running for the ambulance after the first shock, doing CPR along the way.

Definately the emphasis is on continued CPR with minimal breaks in compressions. That's why (or one of the reasons) we no longer reanalyize immediately after the AED shock, and instead do a full cycle of CPR.
 
In Pierce and going to a college for my EMT in pierce. We are told to check pulses. But yes, we don't stop CPR while we're putting on the AED. However, we do check a pulse after the shock before we continue. We do do the correct breath/compressions ratio. We don't put an airway in immediately because of the likeliness that the PT will come out of it throwing up.

That's just what we're learning in school. Not the county protocols. But when I go to class tonight, I'll ask my instructor and give you the exact answer you are looking for.
 
Really it's just worded to follow the new recommendations for CPR from an ALS standpoint; compressions are key, so limit interruptions as much as possible. The best way's to do this from a paramedics standpoint is to check the rhythm, resume compressions and NOT stop until the shock is ready to be delivered, and, for the majority of pt's, intubate while compressions are ongoing. (not as hard as some people think for most pt's).

The not checking for a pulse has to do with what happens immediately after the shock is delivered; even if you briefly see an organized rhythm you still continue compressions, the thinking being that at that point the pt's BP (assuming a perfusing rhythm) will be to low). Doesn't mean don't check for a pulse ever, just not after immediately after each shock, which is what used to be recommended. There really isn't any increased danger, as long as nobody gets to overzealous about defibbing.

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-35
http://cme.medscape.com/viewarticle/518206
 
Well yeah I get the AHA guidelines I was just wondering about the particular ways in which different areas are applying those rules. We all follow the same guiding principals (mostly) but the actual application can be very different. I was interested in the particularly aggressive way Pierce county seemed to be doing it.

Cheers for the links to the protocols and that would be great bunkie, thanks mate.
 
Melclin said:
Well yeah I get the AHA guidelines I was just wondering about the particular ways in which different areas are applying those rules. We all follow the same guiding principals (mostly) but the actual application can be very different. I was interested in the particularly aggressive way Pierce county seemed to be doing it.

Cheers for the links to the protocols and that would be great bunkie, thanks mate.
Click to expand...

My instructor will have the papers I want tomorrow in class. :)
 
Alright, here is by the book for WA state. And now what we're following in class after learning something completely different. :rolleyes:

-CPR is not stopped during application of the pads
-PT is cleared for analysis and shock. We resume CPR immediately after shock, and now do not immediately check pulse as per new guidelines. To insure that we do not get a "false" pulse from the AED.
-CPR is resumed, pulses are checked during compressions to ensure they are adequate and during ventilation to see if the PT has his own pulse (after shock)
-Airway is put in during compressions in 2+ responder. (If the pt suddenly comes to and begins to vomit, we immediately remove it to suction. Still debate between my instructors/evaluators as to what each of them does)
-30 compressions, then a pause while 2 proper breaths are delivered, compressions resume.
-Pulse found during ventilation, compressions are stopped and pulse is confirmed, ventilations continue with BVM O2.
-Pulse checks every 30 seconds. Ventilating until PT respiration is adequate.

Make sense? :wacko:
 
-CPR is not stopped during application of the pads.
I don't quite get how that works. I suppose it might be different with >2 people teams. We work in 2's. Why would CPR be started before the pads went on? When one person is checking for R/A/B/C the other is cutting clothes/putting pads on because its usually fairly clear when they'll be needed. If it didn't go down this way and CPR was in progress, I'm not sure why you would stop to put the pads on anyway, its perfectly easy to slap them on around the person compressing.

-PT is cleared for analysis and shock. We resume CPR immediately after shock, and now do not immediately check pulse as per new guidelines. To insure that we do not get a "false" pulse from the AED.

Yeah that's standard as per the ARC (Australian Resus Council) guidelines as well, which we follow. But we don't use AEDs, when I said analyzing I meant manually and I assumed the article did too as I'm fairly sure it was referring to paramedic level management. So I'm still left wondering if they are compressing during analysis (maybe using those auto correct algorithms on the monitor to correct for the compressions?).

-CPR is resumed, pulses are checked during compressions to ensure they are adequate and during ventilation to see if the PT has his own pulse (after shock)
This is a nice point. We pause everything for pulse and rhythm check. I like the idea of doing it while ventilating. Cuts out time of nil compressions.

-30 compressions, then a pause while 2 proper breaths are delivered, compressions resume.

Yeah I thought so. The article made it sound like they were delivering breaths during compression with BLS airways. Thanks for clearing that up.

Thanks for the effort Bunkie!
 
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