Questions about CPR

mgr22 said:
This thread reminds me how the role of prehospital CPR has changed. When I started in EMS, a solo medic in back during a cardiac arrest was expected to assess an EKG, make a defib decision, intubate, ventilate, start a line, push drugs, and maybe do some chest compressions en route. There were no widely available mechanical devices to help with that.
Click to expand...
when was this? I stared in 1998, and we never had a solo medic in the back on an arrest. Occasionally it was a solo EMT if no medic was available, but I can't imagine having to do all of that by yourself in a moving ambulance.

I have done CPR while standing in a moving ambulance (not that it helped out patient much), but transporting a cardiac arrest solo just sounds like a fruitless task.
 
DrParasite said:
when was this? I stared in 1998, and we never had a solo medic in the back on an arrest. Occasionally it was a solo EMT if no medic was available, but I can't imagine having to do all of that by yourself in a moving ambulance.

I have done CPR while standing in a moving ambulance (not that it helped out patient much), but transporting a cardiac arrest solo just sounds like a fruitless task.
Click to expand...
1992 until things started to change around 2000. Yes, fruitless based on outcomes. Dangerous, too, being untethered in the back with physics and sharps.
 
Rubicon Bob said:
Many in EMS are volunteers, or only work PRN or Part-Time, they do not work EMS as their Full-Time career (paying their mortgage, vehicles, food, etc.)

When I went thru Paramedic school in 1984, we were told the "average" length of time in EMS, for an individual was 5 years

I would hazard a guess that it's about the same now, or perhaps even less since COVID
Click to expand...

What does PRN mean?
 
As required
 
DrParasite said:
when was this? I stared in 1998, and we never had a solo medic in the back on an arrest. Occasionally it was a solo EMT if no medic was available, but I can't imagine having to do all of that by yourself in a moving ambulance.

I have done CPR while standing in a moving ambulance (not that it helped out patient much), but transporting a cardiac arrest solo just sounds like a fruitless task.
Click to expand...
That’s typical 1980s EMS. BTDT.
 
CCCSD said:
That’s typical 1980s EMS. BTDT.
Click to expand...
You would have been in that group that I learned from: guys from the '80s and a few from the '70s. There was more skill than technology or research, with only a suspicion that precordial thumps, Isuprel, bicarb, high-dose epi, and meds down the tube weren't restarting hearts.
 
I have only done mouth to mouth twice in my life, once on duty and once off duty.

The off duty event was in a night club I worked at in the mid 90s. Dude fell over dead, DJ called my name and pointed, I went over and kicked into reflex mode. Got ROSC, dude lived.

The on-duty event is one that still remains high on my list of calls I hate remembering, but it has persisted for many years. Was 2001, I responded for "sick" 3-month-old female. Entered the house, situation was bad/unsafe, scooped the child and hauled *** to the truck. My partner had our bags, I started giving ventilations as I hustled to the truck with the baby cradled in my arms. The engine crew was pulling up as I was crossing the lawn, so the FF jumped in front to drive, my BC had just pulled up as well, so he jumped in back with me and my partner and away we went.

Whole call sucked...involved some work provided debriefing, long story short, this 3-month-old was victim of sexual assault, "dad" the offender was in the house, patient also had multiple fractures, she did not survive. Involved testimony on my part.
 
mgr22 said:
You would have been in that group that I learned from: guys from the '80s and a few from the '70s. There was more skill than technology or research, with only a suspicion that precordial thumps, Isuprel, bicarb, high-dose epi, and meds down the tube weren't restarting hearts.
Click to expand...
I remember seeing medics put meds down the tube when they couldn't get a line... never did make much sense to me, but I guess better than nothing.

and yes, I know many thing have changed since the horse drawn ambulance days.
 
Do not forget escalating dose epi...! LOL
 
PRN is part time but on your schedule (when you want to).


I have worked in EMS for 27 years now, and never done mouth to mouth on a patient, and I have worked over 200 cardiac arrests

Doing CPR varies, a friend was a medic for 22 years, and his 1st CPR patient was also my 1st CPR patient. Luck of the draw, just like some EMS providers never deliver a baby, or never deal with a gunshot or stabbing.

I had a Patient in cardiac arrest this past Thursday, worked him for 45 minutes (10 EMS Providers: 6 from ambulance service {2 trucks} 2 basics, 2 Advanced, 2 medics; 4 FF, 2 basics and 2 advanced). 8 rounds of Epi and 3 rounds of Narcan before we called him.
So far this year at my PT job it has been slow, last year I worked 12 cardiac arrests, got ROSC (Return of Spontaneous Circulation {Pulses}) on 1, 7 just in January (all in the 2 1/2 weeks after ACLS class).
 
mgr22 said:
You would have been in that group that I learned from: guys from the '80s and a few from the '70s. There was more skill than technology or research, with only a suspicion that precordial thumps, Isuprel, bicarb, high-dose epi, and meds down the tube weren't restarting hearts.
Click to expand...
I always tell my students I am a mass murderer, but have an alabi.
 
The last time I researched it, meta analysis revealed that once your heart stops, you have about an 11% chance of surviving but only about a 7% chance of having a normal mental status.

I’ve been on a few that have survived with normal mental status and one patient who we successfully resuscitated and was awake and talking on the way to the hospital. For those skeptics, no I’m not making it up and yes I’m sure he was in arrest. In that case, he received early bystander CPR prior to our arrival..
 
I have 10 CPC 1 or 2 arrest saves and they are ALL because of bystander CPR and defib. Was ALS important? Ehh… I think I might have helped a little, but the bystanders did the important stuff.
 
FiremanMike said:
I’ve been on a few that have survived with normal mental status and one patient who we successfully resuscitated and was awake and talking on the way to the hospital. For those skeptics, no I’m not making it up and yes I’m sure he was in arrest. In that case, he received early bystander CPR prior to our arrival..
Click to expand...
Same here: one prehospital vfib patient alert after early CPR and defib x2. I didn't get ROSC until I started inserting an OPA, which made me wonder whether vagal stimulation had something to do with it. Afterwards I found some supporting '80s research on dogs, although I don't remember anyone teaching that.
 
I've had a couple ROSC in the field over the years. One was a pure CPR save... because I caught it within seconds of the patient going pulseless. I've had more than a few ROSC events in the ED for the same reason. None walked out of my ED... they all ended up either going to a cardiac center or they went to the ICU. I have no follow-up on any of them. Unfortunately.
 
mgr22 said:
This thread reminds me how the role of prehospital CPR has changed. When I started in EMS, a solo medic in back during a cardiac arrest was expected to assess an EKG, make a defib decision, intubate, ventilate, start a line, push drugs, and maybe do some chest compressions en route. There were no widely available mechanical devices to help with that.

Other than timely defib and a good tube, anything else we did instead of CPR probably had less than a 1% chance of making a difference. For every 100 fatal arrests, perhaps 10 could have survived if the priorities had been different.
Click to expand...
That's exactly how things were when I started in the late 1990's. It wasn't uncommon to have a firefighter or two, or occasionally someone from a second ambulance crew ride to the hospital and help out, but that was far from a given. The baseline expectation was that a two-person ambulance crew could handle it.
 
mgr22 said:
You would have been in that group that I learned from: guys from the '80s and a few from the '70s. There was more skill than technology or research, with only a suspicion that precordial thumps, Isuprel, bicarb, high-dose epi, and meds down the tube weren't restarting hearts.
Click to expand...

I don"t know what any of those things mean.

What are precordial thumps? What is Isuprel? What is bicarb? What is high dose epi? What meds would be put down the tube?
 
OP: A lot of what you're asking about is easily searchable on Google or any other search engine that you might be inclined to use. The deep dive into those subjects can take quite a while to understand the reasons something may or may not be used or implemented.
 
MrCurious said:
I don"t know what any of those things mean.

What are precordial thumps? What is Isuprel? What is bicarb? What is high dose epi? What meds would be put down the tube?
Click to expand...
Isuprel, bicarb, and epi are medications that, at times, have been thought to improve the chances of surviving cardiac arrests, usually only temporarily. Some IV medications can be administered down a tube in the throat, although not as effectively as through a vein. A precordial thump is an intentional blow to the chest to try restarting the heart. You'll find much, much more and can explore at your own pace if you follow the good suggestions you got about using a search engine.
 
You must log in or register to reply here.
Back
Top