Writing a piece on CPR, I have some questions

[Sway0230]

Hey guys,

This is a scenario I'm putting into a creative writing piece. just want to run this by you guys for a critique if the following sequence of events is accurate, and also I have a couple of questions for you guys...

1-Dispatched to unresponsive pt
2-arrived on scene to find bystander already had started cpr
3-you would let the by stander continue while you hook up the AED and your partner sets up the oxygen
4-As soon as those things are set up, you take over cpr from the bystander and your partner is ready with the oxygen. you do cpr for 2 mins and then hit the defib.
5-He/she come's back to life


QUESTIONS:
1-how many cycles of CPR/AED does it take on avg for those of you whose pt's have successfully come back?
2-what do you do once he/she's come back? (ie put them on a stretcher with o2 and position of comfort and thats it?)
3-once they've come back is there any common response (ie. are they generally lethargic, do they talk, are they generally vocal about the pain they feel from the broken ribs?, etc)

 

[NomadicMedic]

It's usually not as simple as "get some CPR and a shock and they wake up".

The majority of arrests that I've had with ROSC, the patient is unconscious, intubated, has two IV lines running with cold fluid, maybe dopamine.

Most medics will stay on scene for a few minutes and stabilize a patient post arrest. The patient is vulnerable to a rearrest immediately following ROSC, So we like to hang out for a bit and make sure things aren't going to start going down the drain just as we start to move.

Now, there are instances where patients wake up following a shock and some CPR… But I would think that's more rare than anything else. I've only had that once. That was more like a resurrection than a resuscitation.

You may want to watch a video of a code team: http://www.youtube.com/watch?v=awC_a-LFZXk&feature=share&list=UU_yjveGdyx6mqqHkHaD-_bg

 

[Sandog]

I would be willing to bet that many of those occasions of ROSC, the patient did in fact have a pulse and it was poorly taken prior to CPR.

 

[JPINFV]

Jargon clarification:

ROSC = "return of spontaneous circulation" = pulse.

 

[NomadicMedic]

Jargon clarification:

ROSC = "return of spontaneous circulation" = pulse.

Rodeos only sound cool. :/
Sorry. I should have been a bit more "plain english".

 

[Christopher]

I'll answer your questions first.

QUESTIONS:
1-how many cycles of CPR/AED does it take on avg for those of you whose pt's have successfully come back?
2-what do you do once he/she's come back? (ie put them on a stretcher with o2 and position of comfort and thats it?)
3-once they've come back is there any common response (ie. are they generally lethargic, do they talk, are they generally vocal about the pain they feel from the broken ribs?, etc)

1. If they collapsed in public and a bystander started CPR? Less cycles/shocks needed than the average. A typical successful resus lasts <30 minutes. That being said I've worked patients upwards of 45 minutes and have had survival to discharge.

2. Decrease O2 flow rate, get a Blood Pressure, obtain a 12-Lead ECG, begin/continue therapeutic hypothermia. Once all of this has been done, move to the stretcher, then to the unit.

3. Almost always they are comatose. Even the few times I've had <2-3 minutes from collapse to CPR/AED, they've still been comatose. Does not mean that folks don't "come to", but they're the rarity. Sometimes they "fight", "bite", or "buck" the airway we have placed in their mouth (great sign). These patients will be sedated.

1-Dispatched to unresponsive pt
2-arrived on scene to find bystander already had started cpr
3-you would let the bystander continue while you hook up the AED and your partner sets up the oxygen
4-As soon as those things are set up, you take over cpr from the bystander and your partner is ready with the oxygen. you do cpr for 2 mins and then hit the defib.
5-He/she come's back to life

1 and 2 are fine, might be worth saying their phone is on the floor next to them on Speaker with the dispatcher coaching Hands Only CPR.

It would be nice to hear you say for #3 that you evaluated the bystander's compressions and found them adequate.

As for setting up oxygen, few high performing systems place any initial focus on O2. We'll "get around to it" in the first 2-3 cycles, but it is low on our totem pole, even for BLS systems.

A more common BLS 2-rescuer sequence in our area (pit crew model):

1. Rescuer 1 begins or takes over compressions
2. Rescuer 2 cuts away clothing to place AED pads
3. Rescuer 2 places AED pads
4. Rescuer 2 cuts away pants
5. Rescuer 2 gathers history from the bystanders while waiting for the first 2 minute cycle to complete
6. Rescuer 2 will get out an OPA and Non-Rebreather or BVM (depending on the system), and retrieve a supraglottic airway like a KingLT
7. Rescuer 1 stops compressions once told by the AED and Rescuer 2 gets in position to compress
8. Rescuer 1 will press shock and Rescuer 2 will begin compressions

They will rotate and eventually somebody will place the OPA/NRB combo or OPA/BVM combo, but BVM's are frowned upon if you do not have at least 3 people on scene. We only care about BLS providers rotating compressors and shocking when the AED tells them to. Everything else is BAD (all caps, no survival benefit, do not waste time doing them).

If ALS is on scene, IO/IV established and the CPR triangle is filled out (compressor 1, on-deck compressor 2, airway).

Some good videos for reference:

Portland, OR -> AMR + Portland Fire, textbook code with bystander CPR (MUST WATCH).

Great shot of pit crew filling out

Mesa Fire doing a great job of pit crew

Anything from the Resus Academy

 

[Sway0230]

Guys, I can't thank you enough for your responses. You really educated me a lot and I greatly appreciate it.

Thank you very much and hopefully this piece will come out well!