CPR now its CAB instead of ABC

[Cookie]

I had to do the recertification for CPR last night. The new changes CAB instead of ABC. One of our medics has had us going in this direction for a while. But I have to admit it is hard not to go for the airway first. Any thoughts on the subject?

[Just Plain Ruff]

I just got a forced vacation from my client due to lack of work so I'm going to have at least a week if not two weeks off from work before getting a new client.

I'm planning on taking CPR, ACLS, PALS and NRP if I can find that class all in one week if possible.

Thanks for the heads up for CPR

[akflightmedic]

Yeh I had a lot of questions...back in 2010 when the new guidelines were issued.

[DFIB]

Actually it is a lot easier than opening airway first. Check a pulse, start compressions.

I have heard of some services going to uninterupted compressions with survival ventilations with positive results.

Edited January 12, 2012 by DFIB

[Cookie]

I agree it's a lot easier to go for the pulse then compressions, but when you have been doing it one way for 25 years, it is not an immediate change of mind set. There are other things they changed besides that. Most of them I think are for the better and easier to grasp for the lay person as well.

[tcripp]

Think of it this way. You can stand up and walk to the door while holding your breath...but you can't do the same while having your heart NOT beat.

[Bieber]

I got the chance to attend a presentation earlier this year led by Dr. Gordon Ewy, who you may know as the doctor who came up with the idea of cardiocerebral resuscitation (or CCR). In essence, what Dr. Ewy and his fellow researchers have discovered is that there are two forms of cardiac arrest: primary and secondary. Primary arrest, which is the most common form of arrest (>70%) occurs when a patient's heart stops and they collapse. This is usually due to heart disease, and when the person goes into arrest their spo2 levels are still high (because they were still ventilating and oxygenating normally at the time of the arrest). In primary cardiac arrest, you can expect that the patient will retain acceptably high blood oxygen levels for a while, so the principle concern is to get that blood flowing; oxygenation can be passive via blow by with an NRB without risk to the patient. Secondary cardiac arrest, on the other hand, is the rarer form and occurs when the patient is suffering some form of impedance in their ventilation or oxygenation, and their blood oxygen levels fall and fall until their heart is no longer able to meet its metabolic demands and ceases to beat (or to beat effectively). These are the patients for whom ventilatory support and oxygenation is indicated and, in fact, necessary to regain ROSC.

The principle problem with our management of cardiac arrest is that we treat all forms of cardiac arrest as if they're the same disease, when in fact they're not. Likewise, cardiopulmonary resuscitation is essentially futile in a patient suffering from a traumatic form of arrest, because either they don't have blood to circulate (massive hemorrhage) or there is an obstruction to blood delivery (tension pneumothorax, pericardial tamponade, or tracheobronchial/great vessel damage/obstruction, etc). Because we've tried to treat multiple forms of cardiac arrest with the same care techniques, we've had limited success to resuscitating patients (in addition to other factors, such as inadequate post-resuscitation care).

One of the things I've started to do is to try and identify whether or not a patient is in primary or secondary arrest right off the bat. The best way I've found to determine that is to ask bystanders about their HPI. Were they okay and just collapsed? (Possibly primary arrest.) Were they having trouble breathing and just got worse and worst and collapsed? (Possibly secondary arrest.) What kind of past medical history do they have? (Asthma, CAD, diabetes, etc.)

In order to make significant progress in our treatment of cardiac arrest, we have to recognize that primary cardiac arrest, secondary cardiac arrest, and traumatic cardiac arrest are three very different diseases with three very different treatments, and begin to focus our efforts on optimizing our care based on our impression on the etiology of the arrest to the best of our ability. The reason for the change in the ABC to CAB approach to cardiac arrest is because primary cardiac arrest is by far the most common form of cardiac arrest, while our old treatment was best suited for secondary cardiac arrest (the minority of cardiac arrest forms).

[island emt]

Excellent post Young JEDI warrior! +1