What do you use to guage CPR adequacy?

[kohlerrf]

Agreed generally but if you have ANY detection of ETCO2 production this is a very positive indicator of actual efficacy of forward blood flow/ CPR/ ie some effective perfusion.

Maybe I am reading this incorrectly ... the assumption that pulse ox applied distally during an arrest or that you have a BP of 80 is something I cant get my head around or understand your point, one cannot assume in low perfusion states that the pulse ox is anywhere near reliable and if your using LP 12 do you have C- Lock ON or OFF in default setup ?

Relying on efficacy of change in chest impedance is folly IMHO.

Better explanation may be it measures pulsatile capillary flow, then compares both readings of red vs infrared and calculates, if it hits and sticks on 85 (the cross over on the algorithmic program on the machine) it could be it is one of the artifact result being sunlight contamination, or any other reading could be a direct result of motion artifact, that said if you get a correlated reading best stop compressions and check pulses.

Have you heard of the new inter nasal septal pulse ox probe ? an interesting device as this would be measuring a more central blood flow ... mind you I don't think most awake patients would tolerate a cloths pin in their noses.

Ok first off MAN your OLD LP 3, I loved my LP 4 although it was about 30 kgs but I was young and good looking in those days strong like bull, smart like refrigerator too.

Yea and Physio is playing catch up .... have you seen the new improved LP 15 ?

The ECG pulse rate is dependent on "R" wave within its set algorithm, again try increasing or decreasing ECG size ... Any repeat I repeat any irregular rhythm best check pulse because my rep for Physio has stated clearly it is not to be trusted, as in "extras ventricular complexes" they may or may not be counted, better question are the extras perfusing.

.

Perhaps motion artifact ? again check C- Lock too.

Indications of End Organ perfusion quite simply stated and the NIBP is only a machine too in fact I did a test the other day personally my BP diastolic is 20 mmgs lower from a trained ear to NIBP, so in hypoperfusion states I have lost all respect for that plastic brain ... Seriously to answer you question one would need an in site Art Line and callibrated before an arrest occured (I know putting art lines in an arrest that just ain't going to happen in my lifetime)

cheers

The original question is a little vague with regard to efficacy. My personal indicators are actual perfusion pressure and output of the heart. admittedly based on numerous assumptions we were all taught that if you can get a radial pulse you can estimate the B/P to be at least 80 systolic. Likewise if the pulsox is picking up a clear regular waveform in the capillary beds of the fingertips that are suppled by the radial pulse of 80 systoliccthe same assumption of B/P can be made.

The point being that a manual pulse taken with the excited finger of new EMT or Medic or for that matter a barriatric patient can and often is subjective and inaccurate. The pulsox does not have an excited pulse of its own and is completely objective. Barring patient movement poor connection etc... if the pulsox is detecting a "rate" there is expansion and contraction of the arteriole capillary bed caused by fluid under fluctuating pressure moving through it. In this case we accept the pressure is close to 80 systolic because we agree the minimum pressure to feel a radial pulse is 80 systolic. Again just a cascade of assumptions based on accepted teachings.

Lastly and this cannot be stated enough, if you CANNOT get a rate from the pulsox you CANNOT assume there is no pulse. If CAN get a rate from the pulsox you CAN assume there is a pulse but of what exact pressure you can only estimate.

I am unfamiliar with "C-Lock" could you explain what it is in a little more detail?

[tniuqs]

I am unfamiliar with "C-Lock" could you explain what it is in a little more detail?

Best is to check the CD provided with the monitor although it is a bit confusing too, I had a very similar issue the other day in my Dentist Office while monitoring a conscious sedation patient, he was a past Paramedic and an ex partner.

Man I wish I had done that leap he is LOADED now, sorry off topic.

So try this:

Place the leads on your chest ... observe pulse rate count and change size of QRS complex (no Pulse ox plugged in)

Take the plug off the ECG leads and Plug the PO in .. observe the pleth.

Now plug the ECG leads back in and note the change, this will give you an indication if C-Lock is active.

even have leads on one person and PO on another ... becomes self explanatory of the set condition C-Lock.

The PB patented C -lock is crap in my estimation (I think correlation lock is what that really is) linking PO to ECG, and should be turned off at all times, IMHO especially when pacing that said if one can get into the programming selection ... best done by a bio med tech they can do the changes in selection of default values and if you do it without certification from Medtronic then this can invalidate regulations and if one has the same Service Manuel I havw one can actually plug into a serial port and get to the program "guts" ill advised hell I can't even program my Camera

I tried to cut copy paste the info on page 76 of the CD ... attached below is what I got ... must be protected.

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[meme]

im no expert but....i know if my patients spo2 is 90%+ that the body tissues are being perfused. and i know that if i have a palpable corotid pulse along with the good spo2 that the brain is getting oxygenated blood. i also look at the 3 lead and if when i am doing compressions it looks like the patient is in a huge slow vtach that my compressions are good. all those things together along with my patiens skin color (hopefully not blue) tell me that im doing good cpr.

during a clinical, the fire department brought in a cpr....and the patients face was blue from the neck up.....that was bad cpr!!!

[tniuqs]

im no expert but....i know if my patients spo2 is 90%+ that the body tissues are being perfused. and i know that if i have a palpable corotid pulse along with the good spo2 that the brain is getting oxygenated blood. i also look at the 3 lead and if when i am doing compressions it looks like the patient is in a huge slow vtach that my compressions are good. all those things together along with my patiens skin color (hopefully not blue) tell me that im doing good cpr.

during a clinical, the fire department brought in a cpr....and the patients face was blue from the neck up.....that was bad cpr!!!

What to say ? Welcome and thanks for your input.

[Jwade]

im no expert but....i know if my patients spo2 is 90%+ that the body tissues are being perfused. and i know that if i have a palpable corotid pulse along with the good spo2 that the brain is getting oxygenated blood. i also look at the 3 lead and if when i am doing compressions it looks like the patient is in a huge slow vtach that my compressions are good. all those things together along with my patiens skin color (hopefully not blue) tell me that im doing good cpr.

during a clinical, the fire department brought in a cpr....and the patients face was blue from the neck up.....that was bad cpr!!!

WOW.......Where to even start this reply.....

First, Where in Detroit are you working? As this is my old stomping grounds as well....

Second, I truly hope you don't seriously rely on ANY of the above information you just gave to the masses.....

Here are a few lessons you should probably learn quickly....

1.Pulses

Clinicians frequently try to palpate arterial pulses during chest compressions to assess the effectiveness of compressions. No studies have shown the validity or clinical utility of checking pulses during ongoing CPR. Because there are no valves in the inferior vena cava, retrograde blood flow into the venous system produce femoral vein pulsations.8 Thus palpation of a pulse in the femoral triangle may indicate venous rather than arterial blood flow. Carotid pulsations during CPR do not indicate the efficacy of coronary blood flow or myocardial or cerebral perfusion during CPR.

2.Oximetry

During cardiac arrest, pulse oximetry will not function because pulsatile blood flow is inadequate in peripheral tissue beds. But pulse oximetry is commonly used in emergency departments and critical care units for monitoring patients who are not in arrest because it provides a simple, continuous method of tracking oxyhemoglobin saturation. Normal pulse oximetry saturation, however, does not ensure adequate systemic oxygen delivery because it does not calculate the total oxygen content (O2 bound to hemoglobin + dissolved O2) and adequacy of blood flow (cardiac output).

Tissue oxygen tension is not commonly evaluated during CPR, but it may provide a mechanism to assess tissue perfusion because transconjunctival oxygen tension falls rapidly with cardiac arrest and returns to baseline when spontaneous circulation is restored.

3.End-Tidal CO2 Monitoring

End-tidal CO2 monitoring is a safe and effective noninvasive indicator of cardiac output during CPR and may be an early indicator of ROSC in intubated patients. During cardiac arrest CO2 continues to be generated throughout the body. The major determinant of CO2 excretion is its rate of delivery from the peripheral production sites to the lungs. In the low-flow state during CPR, ventilation is relatively high compared with blood flow, so that the end-tidal CO2 concentration is low. If ventilation is reasonably constant, then changes in end-tidal CO2 concentration reflect changes in cardiac output.

Eight case series have shown that patients who were successfully resuscitated from cardiac arrest had significantly higher end-tidal CO2 levels than patients who could not be resuscitated (LOE 5).2,22–28 Capnometry can also be used as an early indicator of ROSC (LOE 529,30;

4. I would really study up on the Dissociation Curve......

5. Relying on a Pulse OX is the worst thing you could be doing for your patient....Before you go losing your mind about what you were taught in Paramedic school, there is a saying, You don't know, what you don't know. This is what separates the Critical Care providers from the population mean. You might want to read through ALL of VENTMEDIC's posts and learn.

Respectfully,

JW

[tniuqs]

John Wade MBA, FP-C

Bless you my brother I just did not know even how to start.

MEME read the entire topic first please, honestly your so far out of your league, and no offence but ....

cheers

Edited November 3, 2009 by tniuqs

[Siffaliss]

im no expert but....i know if my patients spo2 is 90%+ that the body tissues are being perfused. and i know that if i have a palpable corotid pulse along with the good spo2 that the brain is getting oxygenated blood. i also look at the 3 lead and if when i am doing compressions it looks like the patient is in a huge slow vtach that my compressions are good. all those things together along with my patiens skin color (hopefully not blue) tell me that im doing good cpr.

during a clinical, the fire department brought in a cpr....and the patients face was blue from the neck up.....that was bad cpr!!!

The fire department brought in a CPR ... you mean they brought in a code???

Ok, I can't really say much more than Jwade because he said everything so perfectly (+1 for that one, I'd give more if I could). Here are a few very simple and non-technical things I'd like to point out. How many codes have you actually been on and participated in? Have you NEVER seen a head turn purply/bluey from prolonged CPR? What about the veins in the forehead and temporal areas popping out? Would you also assume someone with cherry red skin complaining of nausea, headache, dizziness, maybe some altered LOC was fine because their sats were 99% on room air? Maybe just a little out of sorts hey? Or not ...

I can't top what Jwade said quite honestly because I'm sure he's got more on me than 4 years, and I'm a little too tired to go browsing through my resources.

What does meme think about all this?

[kohlerrf]

Best is to check the CD provided with the monitor although it is a bit confusing too, I had a very similar issue the other day in my Dentist Office while monitoring a conscious sedation patient, he was a past Paramedic and an ex partner.

Man I wish I had done that leap he is LOADED now, sorry off topic.

So try this:

Place the leads on your chest ... observe pulse rate count and change size of QRS complex (no Pulse ox plugged in)

Take the plug off the ECG leads and Plug the PO in .. observe the pleth.

Now plug the ECG leads back in and note the change, this will give you an indication if C-Lock is active.

even have leads on one person and PO on another ... becomes self explanatory of the set condition C-Lock.

The PB patented C -lock is crap in my estimation (I think correlation lock is what that really is) linking PO to ECG, and should be turned off at all times, IMHO especially when pacing that said if one can get into the programming selection ... best done by a bio med tech they can do the changes in selection of default values and if you do it without certification from Medtronic then this can invalidate regulations and if one has the same Service Manuel I havw one can actually plug into a serial port and get to the program "guts" ill advised hell I can't even program my Camera

I tried to cut copy paste the info on page 76 of the CD ... attached below is what I got ... must be protected.

Hey City senior thanks for the effort! Every day I learn how much I still dont know. I'll follow up with Physio.

"MEME" great though process but remember you can have a O2 sat reading of >90 for several minutes in a patient with no pulse. I think the most intuitive thing you said and often most ovelooked is pt color.

Edited November 3, 2009 by kohlerrf

[Jwade]

John Wade MBA, FP-C

Bless you my brother I just did not know even how to start.

MEME read the entire topic first please, honestly your so far out of your league, and no offence but ....

cheers

Thank you

I feel bad because, this is the kind of information being taught in school as the gospel, when in fact, nothing could be further from the truth......Probably not her fault, as she is just regurgitating what some " Instructor" told her.....

But, she definitely needed to be corrected, and hopefully she can learn something to help provide better care to her patients.

Respectfully,

JW

[Medic One]

I guage it by how many ribs we break....

No really we use several things..

Check pulse while doing CPR

Patients color changes

Skin temp

then with the ALS side we use Capnography and color meters to check tube