Question about CPR

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JohnH

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Hi everyone,

I had a quiz in my EMT B class today and I just had a few questions about CPR

I had a question that said "You arrive on scene and find a unresponsive 60 year old male. He is not breathing and has no pulse. His family states that he has been on ground for 8 mins. What would you immediately do?"

At first I wasn't sure on this one. I put C but then I changed it to A. I remember reading that the quicker the AED is used the better.
In this case, would you do A. 2 mins of CPR then apply AED, B. 5 cycles of CPR with ventilation and then apply AED, or C. immediately apply AED and analyze?
 
JohnH said:
Hi everyone,

I had a quiz in my EMT B class today and I just had a few questions about CPR

I had a question that said "You arrive on scene and find a unresponsive 60 year old male. He is not breathing and has no pulse. His family states that he has been on ground for 8 mins. What would you immediately do?"

At first I wasn't sure on this one. I put C but then I changed it to A. I remember reading that the quicker the AED is used the better.
In this case, would you do A. 2 mins of CPR then apply AED, B. 5 cycles of CPR with ventilation and then apply AED, or C. immediately apply AED and analyze?
Click to expand...

The answer is A. It is an unwitnessed arrest. CPR has not been preformed.

You need to "prime the pump" before you get a whole bunch of deoxygenated blood circulation again.

UNWitnessed = two minutes of cpr then AED
Witnessed= Immediate application of AED.

Confused though... Whats the difference between cpr and cpr with ventilation?
 
Last edited by a moderator:
Anjel1030 said:
The answer is A. It is an unwitnessed arrest. CPR has not been preformed.

You need to "prime the pump" before you get a whole bunch of deoxygenated blood circulation again.

UNWitnessed = two minutes of cpr then AED
Witnessed= Immediate application of AED.

Confused though... Whats the difference between cpr and cpr with ventilation?
Click to expand...

The 5 rounds + Ventillation is saying to do this then:

2 mins, vent
2 mins, vent
2 mins, vent
2 mins, vent
2 mins, vent

Apply AED / Ana / Shock
 
exodus said:
The 5 rounds + Ventillation is saying to do this then:

2 mins, vent
2 mins, vent
2 mins, vent
2 mins, vent
2 mins, vent

Apply AED / Ana / Shock
Click to expand...

oh ok...well that's stupid. lol

So answer is still A
 
I would have picked A.

Unwitnessed arrest gets two mins of CPR before defibrillation. The reasoning is the two minutes of CPR establishes a perfusion pressure which allows the heart to be oxygenated which makes the heart more likely to respond to the defibrillation attempts.

Oxygenated heart responds better to defibrillation.
 
for NR purposes the correct answer is A. and this is straight from my text book "Prehospital Emergency Care 9th Edition" from Brady:

If defibrillation cannot be provided within 4-5 minutes from the onset of cardiac arrest, then the providers should give five cycles of 30:2 compressions/ventilations (about 2 minutes of CPR) prior to defibrillating. This is to provide oxygenated blood, glucose, and other metabolic substrates to the myocardium so that conversion from ventricular fibrillation to a perfusing rhythm is more likely with the defibrillation. If the arrest was witnessed or the known "downtime" has been less than 4 minutes, the provider should first apply the AED, follow the AED sequence, defibrillate if advised, and then initiate or resume CPR.


Hope that helps your understanding
 
I would choose "A" as the answer. I was reviewing my EMT text earlier and that's what it stated. Good luck with everything!
 
exodus said:
The 5 rounds + Ventillation is saying to do this then:

2 mins, vent
2 mins, vent
2 mins, vent
2 mins, vent
2 mins, vent

Apply AED / Ana / Shock
Click to expand...

Actually the 5 rounds are:
30 compressions-vent
30 compressions-vent
30 compressions-vent
30 compressions-vent
30 compressions-vent
That should take about 2 mins. Then you start with the AED.
 
D.

toss a sheet over his head, call the coroner, and go get something for lunch. :)
 
On a follow up note, we(BLS crew) were picking up out of a snf transporting code2 to the ER for ALOC(Not BLS by any means in San Bernardino County). I began to assess the patient while partner was talking to the nurse about an unsigned DNR down the hallway...
Patient is Pale, unresponsive, breathing at about 2 breaths a minute, has a pulse of 52 according to my little $20 Finger Oxy Sat. I look at the Saturation, 80....60....40...30...nada. Pulse is now gone, not breathing and as I look up the patient is yellow. (this event was approx. 30 seconds) Patient Codes, we put the AED on immediately (no shock advised) and start CPR. About 30 mins. go by, by now fire and an ALS ambulance are now on-scene working her. They push Epi/Atropine (i think) and we get a pulse back. Loaded her, and she died at the hospital.

This happened last night, although the patient inevitably died, this was my first witnessed arrest and CPR go around, I was very impressed that with the addition of drugs we were able to restore a pulse for a short time… Anywho, Just wanted to spill my story, still kinda excited about it.
 
RanchoEMT said:
About 30 mins. go by, by now fire and an ALS ambulance are now on-scene working her. They push Epi/Atropine (i think) and we get a pulse back. Loaded her, and she died at the hospital.
Click to expand...

Just out of curiosity, WHY in the world did you guys wait over 30 minutes to transport this arrest patient? To me, she would have been a priority patient (LOC, respiratory rate, and then the cardiac arrest) and would have been a load and go.
 
There are MANY systems that do not transport the majority of cardiac arrests unless ROSC is obtained, with a few exceptions of course. Around here that is the norm if there is ALS on scene.
 
PoeticInjustice said:
There are MANY systems that do not transport the majority of cardiac arrests unless ROSC is obtained, with a few exceptions of course. Around here that is the norm if there is ALS on scene.
Click to expand...

I am HOPING that we go to that soon around here. It is idiotic to run an hour out to a CPR, spend a little while on scene getting an airway and hooking up a monitor, then transporting an hour and 15 minutes back, to a rural hospital. Why the heck, other than in cases of cold water dry drowning or hypothermic arrest would you even consider doing CPR for close to three hours before calling it?
 
PoeticInjustice said:
There are MANY systems that do not transport the majority of cardiac arrests unless ROSC is obtained, with a few exceptions of course. Around here that is the norm if there is ALS on scene.
Click to expand...

Hmm... That is interesting. I may have to do a little research on that. Although, I live in a fairly urban area, so we never have transports over 20 minutes. Thanks for the info. It is always neat to see how other systems do things.
 
Sunyata said:
Hmm... That is interesting. I may have to do a little research on that. Although, I live in a fairly urban area, so we never have transports over 20 minutes. Thanks for the info. It is always neat to see how other systems do things.
Click to expand...

Actually, my FT system is a major city FD with very short transport times, and we still work pts on scene. My PT is a progressive EMS only system and slightly more suburban (15-20min transports), and the pts are worked on scene there, as well.
 
Sunyata said:
Just out of curiosity, WHY in the world did you guys wait over 30 minutes to transport this arrest patient? To me, she would have been a priority patient (LOC, respiratory rate, and then the cardiac arrest) and would have been a load and go.
Click to expand...

We were BLS.... Fire rolled On-scene took over and ALS ambulance followed... they worked her for about 20 minutes on top of our ten. We didn't take her because a certain company policy that states we are to wait until ALS shows up and assumes care.
There has been much discussion in my company about this very topic, my current county protocols state that if a hospital is closer than ALS, TRANSPORT. If ALS is closer, WAIT. Which is how things *should* run. But my company "the big One" has a Stay and Play policy until ALS shows up.... Obviously this is for the BLS side of the company. Believe Me, I would like nothing more than to fire up the roof on a BLS IFT Ambulance(assuming they still work) and run code3 to the hospital. But! can’t do it, without a :censored::censored::censored::censored: storm to follow. At least Not until this :censored::censored::censored::censored:, gets taken care of (prolly won't)... Major Conflict of Interest Here. Company Protocol vs. County Protocol. Maybe an opportunity for employee lawsuit is hidden here...
 
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