New ACLS Save!

[etfink]

Great call last night:

Dispatched C3 for a MVA, minor damage. U/A pt found slumped over steering wheel, unresponsive, apneic, pulseless. Wife states pt became unresponsive drifted and struck parked car.

Pt was rapidly extricated to long board. Here is where it gets cool:

Per new protocols for unwitnessed arrest began continuous chest compressions 100 per min for 2 min while bagging every 5 sec. Pt placed on monitor which showed microfine v-fib. Pt shocked once at 360J. Converted to PEA with a rate of 75. Intubated, two IVs established 14s in right and left ACs NS wide open. 250cc fluid challenge. Palpable radial pulses present. BP 80/palp. Rapid transport. En route: Lidocaine bolus and drip hung. At hospital pt started bucking the tube, pupils were reactive and bp raised to 125/77.

Discussion-

While this was just a single point of reference I really liked the 200 compressions prior to any other inverventions. The theory is that the heart needs to be primed and that there is sufficient O2 left in the blood stream. Another collateral advantage was that it gave us 2 minutes to organize, get equipment and meds staged and compose ourselves. I really don't see how this call could have run better.

I just wanted to run this by the forum because this is the first cod I've run under the new protocols. What have you seen out there?

By the way I just got the call last Friday that I've been accepted to medic school in Jan. I can't wait, I'm already studying every free second I have.

[Shelbmedic]

sounds like a good call

[etfink]

Thanks it was. It was one of those calls that make all of the "flu-like symptoms" worth it. LOL

[vs-eh?]

A question...

You did "continuous chest compressions 100 per min for 2 min while bagging every 5 sec"? This is synchronous or asynchronous? It kind of flies in the face of the "prime the pump" theory and increased intrathoracic pressure theory (you don't want) of the 2005 ACLS guidelines. You are stopping compressions every 5 secs? Then you are not doing an efficient job at "priming the pump". You are ventilating asynchromously a non-intubated pt? Not effective (obviously) and increased risk of gastric insufflation and increased intrathoracic pressure. Doesn't make sense. Please explain...

[etfink]

Sorry I was not clear. Our medical direction is to ventilate via BVM if a second rescuer is available. You do not stop compressions.

[Lithium]

Doesn't make sense. Please explain...

Do you have to rain on everyones parade?

[vs-eh?]

Sorry I was not clear. Our medical direction is to ventilate via BVM if a second rescuer is available. You do not stop compressions.

Ya but...

So then you do asynchronous CPR and ventilations with a non-intubated patient? I have never heard of it. Has anyone else heard of similar protocols or have previous ACLS standards said that?

At minimum it would be ineffective and at worse could increase gastric insufflation and intrathoracic pressure (I would think). I would think it would be a natural tendency to ventilate harder during this (because oxygen is being directly forced from the chest) and you would want to overcome this. It is more of an open system, as opposed to a more closed system of ventilating an intubated patient. The more forceful PPV would increase the risk of stomach distension (forcing open the cardiac sphincter) and air-trapping no?

Meh, maybe I'm wrong....

Do you have to rain on everyones parade?

Yes...Yes I do... :wink:

[Thunderchild145]

No. You're not wrong. It's definately weird.

[etfink]

We are involved in a prehospital study, so the protocols may seem a little weird. To be very honest it is frustrating because several departments are using the old AHA protocols, some using new protocols and some are involved with this study. Because of the system several agencies often work together and there can cause confusion. I will look into wether we were wrong to bag before intubation. I don't believe we were. Thanks for the feedback.

[hammerpcp]

The pt survived so therefore they were doing something right.