CPR Changes.. have you changed?

[akroeze]

BLS nitro is another story alltogether though. Most good medics I know really try to avoid giving NTG without an IV line established in case the pressure begins to tank. I really doubt any medical control would be willing to give standing order NTG to BLS providers who are unable to start IVs and give fluids. Maaaaybe for EMT-Is, but even then I beleive (although I'm not sure) that these providers lack the A+P background necessary to understand the indications and contraindications of fluid bolus treatment for hypotensive patients. Correct me if I'm wrong there.

As a PCP in Ontario I would not be surprised to give Nitro atleast once per shift if not more all without IV access.

[stcommodore]

I believe we can assist the patient with there nitro and call command for other usage past that for Nitro in my system. ASA seems alot better on the risk vs. benifit side of things at least when I'm looking at it.

[VillageEMT]

Here a Basic can "assist" the pt with their own nitro only if their BP is above 120. ASA for Basics has been proposed in our region and may happen this year.

Now for "on topic:" We haven't started using the new protocols yet. They will be implemented this fall as part of our CPR recert. Our LifePac 12s and 500s will be changed over to 360 joules at that time. Stats for the "old way"... last year, seven CPRs, one save. There were about a dozen "near misses" that made it to the ED in time with a lot of help from ALS. It is so nice to work with a guy who has been an EMT for 35 years and can get an IV into an obese diabetic on the first try almost every time, or the second try every time.

[stcommodore]

How about the push away from ET drugs and IO or IV. I know we rolled out the ez-IO guns to some degree because of that.

[Lithium]

Akroeze, remember, you have a two-year, full-time ~1600 hour college diploma in paramedicine, our friends to the south, their entry level only requires around less than 200.

Although, I'll admit I prefer to have a line in place before giving ANY drug, just part of my normal regime.

[northernmedic]

In the process of training all 3300 of our staff. I think around 1000 are done. Not sure what the numbers are like so far. I've done 4 codes the past two weeks and all were trauma so I don't think they really count.

[JPINFV]

[rant]

You know what? I'm sick of this "Have you been trained" or "We'll switch when everyone gets trained" BS. We sit here and preach about how "protocols are guideline" blah blah blah, but when push comes to shove we refuse to change. Is it really that hard to tell people, "You know how you you use to do 15 pushes between when I squeezed the bag thingee? Yea, well push 30 times now" "You know how you used to do 3 analyze/shocks and then CPR? Yea, well do 1 shock now and 2 minutes of CPR before you try again."

The only problem you should have is reprogramming the AEDs, and even then, the management should have it either done or scheduled by now. These changes aren't that ground breaking, for the most part its changing a damn ratio with a few minor changes depending on arrival at an arrest (basically do 2 minutes of CPR before turning on the automatic lunch box of life if your responding on an ambulance because you probably didn't arrive there that quickly. CPR PTA counts for this). If you truly believe that protocols are guidelines, then take charge during an arrest and do what the evidence currently shows to work. If you don't, then all the talk on this board about "guidelines" and "evidence based medicine" is a sham! [/end rant]

[rdelisle]

Hey all. Rumor has it we're switching over to the new standards in October and getting our AEDs re-programed at that time. In anticipation our service purchased the "CPR Anywhere" kits from Laerdal so our people can get a head start on the practice and timings for the new standards.

[BlackSheep]

It is my understanding there are new protocols for performing the Heimlich maneuver, have any of you had the training?[/font:5cb9c87899]

[JPINFV]

^

No, I haven't. So I did what every provider should do, I looked up the new guidelines

http://americanheart.org/downloadable/hear...2Winter2005.pdf

Streamlining Actions for Relief of Foreign-Body Airway Obstruction 2005 (New): Terms used to distinguish choking victims who require intervention (eg, abdominal thrusts or back slaps and chest thrusts) from those who do not have been simplified to refer only to signs of mild versus severe airway obstruction. Rescuers should act if they observe signs of severe airway obstruction: poor air exchange and increased breathing diffi culty, a silent cough,cyanosis, or inability to speak or breathe. Rescuers should ask 1 question: “Are you choking?” If the victim nods yes, help is needed.

If the victim becomes unresponsive, all rescuers are instructed to activate the emergency response number at the appropriate time and provide CPR. There is one change from 2000: every time the rescuer opens the airway (with a head tilt–chin lift) to deliver rescue breaths, the rescuer should look in the mouth and remove an object if one is seen. The tonguejaw lift is no longer taught, and blind finger sweeps should not be performed.

2000 (Old): Rescuers were taught to recognize partial airway obstruction with good air exchange, partial airway obstruction with poor air exchange, and complete airway obstruction. Rescuers were taught to ask the victim 2 questions: “Are you choking?” (the victim who needs help must nod yes) and “Can you speak?” (the victim with obstructed airway must shake his or her head no). In treating the unresponsive victim with FBAO, the healthcare provider was taught a complicated sequence that included abdominal thrusts.

Why: The goal of these revisions is simplification. Experts could find no evidence that a complicated series of maneuvers is any more effective than simple CPR. Some studies showed that chest compressions performed during CPR increased intrathoracic pressure as high as or higher than abdominal thrusts. Blind finger sweeps may result in injury to the victim’s mouth and throat or to the rescuer’s finger with no evidence of effectiveness.

So, no more blind finger sweeps, no more "Tounge jaw lifts" (what ever those were), only ask one question, and just do CPR if the patient collapses.

1. These again aren't the most life shattering changes.

2 Again, if an EMS provider is too stupid to read up on highly publicized changes that are constantly being talked about, then maybe they should find another field to work in. One that doesn't change after new evidence and one that doesn't involve people's lives.