Cardiac Arrests: Stopping To Check Pulses?

[AnthonyM83]

When do you guys check pulses (for ALS, only) during an arrest?

How do you cycle through you rhythm checks?

I've been told best practice is:

Discover No Pulse

Being CPR

2 Minutes

1st rhythm check (with pulse check)

Shock/No Shock

Immediate CPR (w/o chance to see rhythm)

Push drug appropriate for last rhythm seen (even if it may have converted after the shock)

2 minutes

Rhythm/Pulse Check

Shock/No Shock

Immediate CPR

Drug for previous rhythm seen

etc etc

I've also been told by some medics they take a moment after the shock to see if there was rhythm conversion after shock, then continue with the 2 minutes.

Also, if you happen to see a distinct rhythm change during the 2 minutes of CPR after (even though it's hard to see b/c of compressions), do you stop and check pulse or finish out the 2 minute round?

(This is all of course assuming intubation with asynchronous CPR where you can't do a pulse/rhythm check while person stops CPR to give breaths every 30 seconds)

Just looking to see how different medics run their codes and stagger their drugs and rhythm/pulse checks (and if they respond to them or finish their 2 minutes), AS WELL AS what they consider 'best practice'...

Edited March 26, 2009 by AnthonyM83

[firedoc5]

I don't think you'll get the same completely identical answer twice. If you went by someone that totally went by "book learnin" it will depend of which book they read, not all the same. And I don't think every instructor teaches the same as all other instructors. I could go on, but....

I can't give an absolute answer on how I would check it. The best I could say is that check it to see if CPR is necessary, after about 2-3 min. of CPR. With ALS, just after intubating, after every defib. Any change in the monitor (treat your pt. not your monitor). 10-15 seconds after each med. administration.

I'm not saying that is exactly how I always did it, but it's an approximation guideline I used. Sometimes I might have checked it more often, and others not as often.

Look for a wide assortment of answers.

[FL_Medic]

I check a pulse during chest compressions to make sure they are effective and to rule out volume issues.

I check a pulse with every rhythm change unless obvious V-fib or. asystole. I find apical auscultation to be the fastest and easiest. Before I call a death in the field I listen to the heart.

[zzyzx]

Anthony, there's no point in doing pulse checks (after your intial assessment) until you see an organized rhythm on the monitor. Why check for pulses when you see asystole? You do however want to briefly stop CPR at regular intervals (and esp. before you push drugs) to be able to read what's on the monitor.

On the first full arrest I ever ran, I wasn't expecting the guy to get a rhythm back because he had an unknown downtime, was asystole, and I had only given 1 round of drugs down the tube. Drugs down the tube aren't supposed to work, right? I had just established an IV and was about to push epi, but just before I did my EMT partner, who was looking at the monitor, said, "Wow, it looks like he's got something back." Our patient had just gotten a rhythm back with pulses. If I had pushed the epi, I might've sent him back into cardiac arrest.

Edited March 27, 2009 by zzyzx

[robsta]

In short I do not. I often attend by myself. I pretty much concentrate on sticking to the DRABC, getting on with good compressions and monitor/defib.

My understanding was the check for pulse guideline was dropped because it was a waste of valuable compression time and most of us are not very good at it. Hence the signs of life assessment

Rob

http://isolatedrn.blogspot.com

[BEorP]

I check a pulse during chest compressions to make sure they are effective and to rule out volume issues

Could you please provide evidence that the presence of a "pulse" is proof of adequate chest compressions?

[Dustdevil]

In short I do not. I often attend by myself. I pretty much concentrate on sticking to the DRABC, getting on with good compressions and monitor/defib.

DRABC? That's a new one on me.

Is this an Aussie thing, or am I just out of the loop?

[FL_Medic]

Could you please provide evidence that the presence of a "pulse" is proof of adequate chest compressions?

I guess this would just be common since and my OPINION. Why do we check for a pulse in the first place? If the patient is pulseless, and has a pulse with chest compressions I would assume at least the depth of the compressions is adequate depending on the pulse location. Not to say that if a pulse is still absent that chest compressions are inadequate.

[BEorP]

I guess this would just be common since and my OPINION. Why do we check for a pulse in the first place? If the patient is pulseless, and has a pulse with chest compressions I would assume at least the depth of the compressions is adequate depending on the pulse location. Not to say that if a pulse is still absent that chest compressions are inadequate.

There is no evidence to support the practice so I wouldn't be wasting my time on this useless assessment if I were you. We can never truly become a profession that practices evidence based medicine if people keep doing things that they think are right or things that they do because "that's the way it's always been done."

[FL_Medic]

There is no evidence to support the practice so I wouldn't be wasting my time on this useless assessment if I were you. We can never truly become a profession that practices evidence based medicine if people keep doing things that they think are right or things that they do because "that's the way it's always been done."

You are right, checking a pulse during compressions is stupid. Don't know why I have been wasting those 5 seconds to feel if a pulse is present during compressions. Give me a break. It's one thing if I was choosing not to give Vasopressin, or choosing to give all my drugs down the tube. Show me the evidence that checking for a pulse during compressions is hurting patients. Just because they don't do research on it doesn't mean that it doesn't work.