Baby Paramedic with a question regarding pacing

[chbare]

I cannot see how the statement in question applies to CPR pulse checks per se? It was based on electrical versus mechanical capture in the setting of TCP. I think he was simply saying you can have electrical capture without the presence of mechanical capture or a pulse.

Take care,

chbare.

[Jwade]

I cannot see how the statement in question applies to CPR pulse checks per se? It was based on electrical versus mechanical capture in the setting of TCP. I think he was simply saying you can have electrical capture without the presence of mechanical capture or a pulse.

Take care,

chbare.

CH,

That is why I asked for clarification,

I simply provided the article as a refresher just in case....

Respectfully,

JW

[FL_Medic]

Pacing is used to try to increase heart rate.

Compressions provide a mechanical pulse.

Without a mechanical pulse, the electrical heart rate provided by pacing is of little use.

Think of reasons they are in arrest. Pacing does not ultimately cure any of them.

When you are providing chest compressions, you are pumping the blood out of the heart because the heart isn't able to do it on it's own. The pacemaker internal or external, does not pump blood. It attempts to stimulate the heart's own electrical pathways in hopes of having a mechanical reaction. Thus, the heart of a patient in cardiac arrest has gone beyond the point of pacemaker usefulness.

I have seem few try pacing in cardiac arrest, and it has never worked. I really wonder if anyone has seen it work?

I figure you can always try pacing, but chances are it is not going to circulate or get capture. Is the capture a femoral pulse or just capture on the monitor?

I have to agree with Mike. Even here in the city where I work we work the cardiac arrest for 20 minutes with a few other basic criteria but do not transport if no ROSC after calling medical control. There is more criteria to it than that but that is the basic of the protocol.

Pacing was part of the PEA/Asystole recommendations from AHA. I believe it was removed in '05.

[Siffaliss]

Would pacing hurt someone who was already dead? Of course not.

Are you likely to get electrical capture on confirmed asystole, even with the gain turned up all the way on your monitor to detect any little spark? No. They're dead, there is no spark.

Would you get mechanical capture without a yes answer to the above? No.

To the original poster, do you guys get ACLS training there?

[maverick56]

I also live in a very rural area and most services have pretty long transport times. Quite a few of the more outlying services around here are using the LUCAS automated CPR device to help avoid situations like the one you described. I haven't had the opportunity to use it myself yet (I'm still job hunting), but from what I hear from guys in my medic class, it's been a huge advantage in cardiac cases. The nearest cardiologist is at least 40 min for all in my class, up to 2hrs for some, and they are small depts, usually just 2-man teams with 1 medic, 1 basic. This device not only saves a set of hands (and energy), it provides more effective CPR by providing an active decompression, allowing a greater decrease in interthoracic pressure (during recoil) and an increase in venous return.

LUCAS

Edited April 28, 2010 by maverick56

[armymedic571]

To the OP. Great question. Don't be afraid to ask those questions. In the end, there is only one way your going to learn...ASK. As I believe JWade has already asnwered, I will let it rest.

I would like to ask about your medical command physician. Does he/she update on new information when your service does? Often, in my area we have many that have "paradigmitis", or in other words, people who do not want to except that evidence based medical facts are changing the landscape and scope of our practice. The statment, "Because that is the way we've always done it" not longer is appropriate.

If you can no longer perform adequate and effective CPR, there is no reason to attempt to continue.

Best of luck to you and your partner. Continue to learn and improve.

J

Sorry, I had something to say on the LUCAS. Our service tested the pnuematic LUCAS device with Catostrophic effects. I believe one liver, one spleen and two pnuemothorax's. None of which could be contributed to misplacement of the device or user error. HOWEVER, a service to the north of us, is testing a newer electonic version of the device, and they seem (anectodally) to be getting very positive results.

To go along with this, I have been told that in the next batch of AHA recommendations that they are going to push for even more compressions per minute, which could further effect provider fatigue in these circumstances.

Edited April 28, 2010 by armymedic571

[ambodriver]

someone needs to work on their cardio...heehe, but if you have a long transport time, I'd call the patient on scene if I was able to

Edited May 14, 2010 by ambodriver

[DwayneEMTP]

Now I remember why it's not a good idea to post at 0300...

I can't see it at all. I think it was a great question and I immediately though, "Oh shit...I know it won't work, or so I've believed, but how come??"

I don't get the negative rating. The one thing that I hate about the popularity ratings is that it lets any shithead post negatives but doesn't force them to post their reasoning. I'm calling bullshit on your negative rating brother, and will fix it.

Maybe the answer to your question is obvious to many here, but not most, and that's what a thinking, educating forum is about, right? And you know what? The City is shit without people like you that have the balls to post questions that they think they might take a beating on. What good is this place if we only ask questions that will stump Dust, chbare, ak, billygoatpete? I might as well just download (more) porn.

Good for you brother. Thanks for being part of this thing we do here. Thanks for participating. And thanks for your question.

I simply don't have a specific answer to offer.

Dwayne