Cardiac Arrests: Stopping To Check Pulses?

[akroeze]

As a side note, AHA is scheduled to come out with new guidelines in Dec 2009.

Are there any "leaked previews" of what is to come?

[akflightmedic]

Are there any "leaked previews" of what is to come?

Do not be surprised if you see 50:2 or 100:2 compression/ventilation ratio.

[island emt]

Just get an Autopulse: Continuous compressions all the time, until you hit the stop button.

[tniuqs]

Do not be surprised if you see 50:2 or 100:2 compression/ventilation ratio.

With a bit of respiratory background, I can see some limits in the concept of increased compressions versus breaths, human physilology still remains that even and not under duress/extremus we need this exchange of gasses .... Oddly, I still breath at 10 to 12 breaths per minute, although on rare occasion I can breath through my ears.

Agreed that the change from 15:2 vs 30:2 on the one man CPR has shown some statistical improvement in outcomes. Continuous compressions from the Professional level providers ie 5:1 (intubated) interposed as in Hospital arrest outcomes are far better and is still the accepted norm, tidal volume and the risk of DHI (Dynamic Hyperventilation) and auto PEEP being a better understood at the EMS levels, Perhaps we will limit the (PIP) ie peak inspiratory pressures and yet another opportunity to reinvent the wheel / gagets and further stimulate the economy.

The efficacy of chest compressions (only) to actually provide adequate gas exchange during arrest is still very "theroretical" very understudied, sometimes misunderstood to the extreme, I just love paying more to (fill in the blank ... Heart Foundation Funding) for my bi annual and multiple cards/ money ... argh have to agree with crotch on that one !

ILCOR is in most cases is the entity that drives standards internationally, the other National Heart Fundations "usually" just accept the recomendations, can you believe the 30:2 was delayed in Canada by at least a year based purely on the printers abilities to go to press .. indead ! Please dont get me going on the warm soft fyzzy new ACLS courses .. sheesh.

What is studied is the number of people "in out of hospital arrest" and the initiation of the public to start earlier with ventilations or CPR at all, the impedance is the public fear of recieving some form of illness, the biggest influence .... that said oddly enough birth rates remain the same ?

Biggest point being the old Protocol question AGAIN ... these CPR sequences / step by step instructions are a means to an end for teaching as a relative standard ONLY.

Again I check pulses whenever I feel a the need too, heck but then I don't even follow pancake recipes printed on the box when cooking ..... cheers

Edited April 5, 2009 by tniuqs

[brentoli]

Do not be surprised if you see 50:2 or 100:2 compression/ventilation ratio.

What about the rural providers who can't count that high?

*hides*

[akflightmedic]

What about the rural providers who can't count that high?

*hides*

Compress for as long as it would take you to spit tobacco juice 5 times into your soda can/bottle.

[Mateo_1387]

Hate to break the bad news to you, but it really doesnt matter in most areas. Due to our long response times, and an uneducated public that will not start CPR, you are basically working a corpse. Unless the percentage of cardiac arrests patients that walk out of a hospital has changed, the vast majority of these patients are dead, and will stay dead, but if you pump enough drugs in them over 20 minutes, you might get the heart beating again long enough to drive L&S to the ER so they can be pronounced there or in the ICU. So check a pulse every second, check one every 20 minutes -- doesnt matter. And dont worryabout AHA too much, as they change the rules every two years, solely for the purpose of making you buy a new text book.

With hypothermia, more cardiac arrest patients are surviving nuerologically intact.

[wrmedic82]

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 talk about evidence based medicine and yet there is not a shred of documented proof that ACLS drugs have better outcomes, or even work at all in patients in cardiac arrests. Don't get me wrong Im not advocating against giving vasopressin, epi, or atropine. But I find your comment somewhat hypocritical.

Some things to look at

http://content.nejm.org/cgi/content/extract/340/22/1763

http://www.annals.org/cgi/content/full/129/6/501

http://www.ncbi.nlm.nih.gov/pubmed/7023292

http://www.eboncall.org/CATs/81.html

http://www.ncbi.nlm.nih.gov/pubmed/15642869

However I did dig up a couple articles about checking for pulses being ineffective. To each their own. Im not against checking pulses during CPR nor do I think that stopping to check for a pulse during CPR really has a true negative outcome. Thats my story and Im sticking to it.

http://emcrit.org/1-resus/007-adult.resus.htm

http://www.merck.com/mmpe/sec06/ch064/ch064d.html

Edited April 5, 2009 by wrmedic82

[tniuqs]

Compress for as long as it would take you to spit tobacco juice 5 times into your soda can/bottle.

Must WHOLE HEARTEDLY DISAGREE .... this is ABSOLUTLEY NOT IN Billy Bobs Protocols !

Correction : Into your BEER CAN :>)

sheesh AK !

[wrmedic82]

Must WHOLE HEARTEDLY DISAGREE .... this is ABSOLUTLEY NOT IN Billy Bobs Protocols !

Correction : Into your BEER CAN :>)

sheesh AK !

YES!!!!!!!