Return of spontaneous circulation question?

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patzyboi

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When performing CPR, if you dont reanalyze ABCs, what do you do if you shock a patient and their heart starts again, but is unconscious and apneic?
Since you dont reanalyze the patient's ABCs, you dont know that they have a heart rate again, and you dont palpate for pulse.

Does the AED tell you that the patient has a normal rhythm?
 
I think the AHA found that even if they have a perfusing rhythm, it may take a minute or so for capture (from the heart's electrical system), they found that doing an additional 2 minutes of CPR will not cause harm to the patient, and it may in fact benefit them. You're suppose to look for signs of life as you're doing CPR eg the patient starts to breath on their own, they move. I think, but I'm not sure, that you're suppose to check the pulse if the AED says no shock advise.
 
After the aed delivers a shock, continue cpr.

BTW Asystole and PEA
 
I think he knows that he's suppose to continue CPR after shocking the patient, but he's wondering how will you know if they have a pulse back or not if you don't check for a pulse after shocking. I was saying that it's okay to do CPR for an additional 2 minutes even if they have a pulse back, you'll know when you see signs of life, or when the AED analyzes the rhythm and says "no shock advice", then you check for a pulse to see if they have a pulse, or pulseless electrical activity (PEA) or asystole.

I just forget if the AHA, lol, wanted us to check for a pulse if it says "no shock advise". I recall they were trying to deemphasize that since even healthcare providers suck at pulse checks.
 
patzyboi said:
When performing CPR, if you dont reanalyze ABCs, what do you do if you shock a patient and their heart starts again, but is unconscious and apneic?
Since you dont reanalyze the patient's ABCs, you dont know that they have a heart rate again, and you dont palpate for pulse.

Does the AED tell you that the patient has a normal rhythm?
Click to expand...

An AED only monitors electrical activity in order to determine "Non-shockable" versus "Shockable". The computer algorithms are pretty smart at this classification, but these are not a surrogate for "Patient has a pulse".

Ultimately the most common post-defibrillation/cardioversion rhythm is asystole.

Usual progression of a successful defib looks like: VF/VT -> defib -> asystole (good thing) -> PEA -> perfusing rhythm.

So, pumping on the chest for another 2 minutes is the right answer.
 
A. PULSE/no resp=rescue breathing and airway.Recheck pulse frequently.

B. ELECTRICAL ACTIVITY and no resp=check pulse, see above.

BASIC LAYPERSON CPR: no pulse-check in algorithm, so compress until signs of life etc. Followe AED prompts. Rescue breathing as needed. See D below.

PROFESSIONAL RESPONDER: see A and B, and below:

C. PULSELESS BUT HAS ELECTRICAL ACTIVITY PER EKG (not AED): compressions, drugs and shocks per protocols. This is PEA.

D. RESP BUT NO ELECTRICAL ACTIVITY: agonal breathng or sensor malfunction.


Just because you are a paramedic does not mean a simple airway position issue is impossible.
Just because they regained a pulse does not mean it won't stop again. Recheck frequently. Keep pt awake if possible, loss of consciousness is a reliable sign something's gone bad.
 
shouting1.jpg


TRADEDMARK! TRADEMARK!

Of course, I'm the guy who carried ammonia poppers all the time, so MY "unconscious" may not match YOUR "unconscious".

Naw, go ahead. Works for me every CPR class I teach!
 
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mycrofft said:
Just because they regained a pulse does not mean it won't stop again. .
Click to expand...

Maybe it's just me but they generally don't stay around for very long more times than not. Can anyone say "medication sustained"?

OP, if the AED advise no shock, reassess ABCs or CABs or whatever the hell it is now.

We cheat with ETCO at the ALS level. Jump up in ETCO values usually indicates ROSC and requires a reassessment. With that said, ALS doesn't mean you skip past the basics. Organized rhythm on the monitor or first responder's AED advises no shock upon our arrival we are going to reassess and see if we are dealing with a PEA/Asystole scenario or ROSC.

Security got ROSC the other night right as we showed up. I was so proud, especially since the last code I ran with that security crew was a complete disaster. Not on their part, just the whole situation.
 
The short answer at the BLS level is to keep plugging along until you see signs of life (improved skin signs, respiratory effort, perhaps even movement), especially if you get a "no shock advised" or two (or the AED actually tells you to check them).

ALS folks are supposed to do something similar, but can actually view the rhythm during any pauses in compressions (which should be few!), or depending on equipment may be able to read the rhythm "through" the compressions. But they have the added tool of end-tidal CO2, which usually announces ROSC by increasingly dramatically. That signals the same thing as the aforementioned clinical signs; gee, looks like he's doing better, let's check pulses.
 
Brandon Oto said:
The short answer at the BLS level is to keep plugging along until you see signs of life (improved skin signs, respiratory effort, perhaps even movement), especially if you get a "no shock advised" or two (or the AED actually tells you to check them).

ALS folks are supposed to do something similar, but can actually view the rhythm during any pauses in compressions (which should be few!), or depending on equipment may be able to read the rhythm "through" the compressions. But they have the added tool of end-tidal CO2, which usually announces ROSC by increasingly dramatically. That signals the same thing as the aforementioned clinical signs; gee, looks like he's doing better, let's check pulses.
Click to expand...

Skin signs are not a criterion for layperson (nor ARC pro) CPR to cease. Just means you get a gold star for your CPR!
 
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