Doctor sparks debate over CPR

[PairofMedics]

I agree 110%...like all changes in medicine, CCC-CPR must stand up to the test before we announce sweeping changes. I know that my medical director has stated that he embraces CCC-CPR for the layperson, but has no plans to take away our advanced airway management techniques (Intubation-oral or nasal, LMA, combi-tubes, and emergency trachs). But he does like the idea of laypersons and potentially basic 1st responders doing CCC-CPR, *IF* the data holds up.

I am all for laypersons doing whatever they can to help. I've told many of my own students to pay attention to their limitations, and CCC is better than nothing...it's anaerobic metabolism, but it's a start. The big problem I have is that he's convincing actual ALS providers and services to bypass and essentially ignore airway and oxygenation before the facts are in from the field trials and the AHA has had a chance to review. You know, someone else here ridiculed me about my mentioning of the standards we must adhere to, and his interpretation of my statement was that we perform to a standard and no more than that. He's got it backwards! We must perform to a minimum standard, but are encouraged to perform at a higher level. Going the extra mile is what we're all about.

 

[PairofMedics]

Do the ribs flex or bow when chest compressions are done? Of course they do, and it is this flexing of the ribs that is creating a bellows effect with the lungs. Air is is moved in and out of the lungs with each compression/release cycle. There is no need to use the full capacity of the lungs to accomplish oxygenation. People with severly diseased or impaired lungs survive quite well. An unconscious person doesn't need much oxygen to survive.

Keep in mind the CCC procedure is mostly aimed at the lay person with no other support equipment. They are simply trying to "buy" the patient a little time until the EMT's and or paramedics arrive with O2 delivery systems, intubation capabilities and medications let alone the extra manpower.

Actually it's the diaphragm contracting and reducing the air pressure in the lungs that cause respiration. What you are describing is passive airway...an airway that is maintained without conscious control while we are awake. During a cardic arrest the muscle tone of the superior airway is lost and the tongue occludes the oropharynx. Therefore without active airway assistance there is no passage of oxygen. This is precisely why so much attention is paid to obtaining and securing a clear airway.

 

[PairofMedics]

OK, time for my two cents here. Pair O medics is quite clearly a cook book medic. Read the cook book and follow it to the letter and never stop to look outside the box. I have been involved in EMS since 1979 and am in my 20th year as a paramedic including flight medic, ect. I was critical of this "new" advancement but chose to look further into it. After reading and talking with Mookie Mouse? a while back when this came up, Im sold. This will be the new standard in the very near future. The numbers are there, it works!.....For now, do what you were trained to do. Pump and blow.

45 minutes to run a code on scene? Cripes! Remind me to stay healthy there.

I'm 24-0 on codes, by the way. And if you want to call me a cook book medic because I don't make the rules up as I go along so be it. It's just like giving a medication...you give the appropriate dose for the patient and their circumstances. There are some things you can bend, some more than others...like giving some Lasix with a slightly lower than preferable BP...but you're piggybacking the Dopamine next and pulling them out of cardiogenic shock secondary to CHF. But the Lasix dose is still weight based...hot dog it and you'll pay the consequences for practicing medicine without a license. And preferably I'd like to keep my patients from crashing...they live longer that way.

 

[ParamedicDiver1]

I'm 24-0 on codes...

Hey PoM What do you mean 24-0? Just courious if you are saying you have 24 saves or 24 codes or 24...ummm...something.

 

[Wildcard]

Hey PoM What do you mean 24-0? Just courious if you are saying you have 24 saves or 24 codes or 24...ummm...something.

OMG he has run 24 codes and feels qualified to debate this topic!!!!! I ran 4 back to back before noon one day.How the hell did you get on as a flight medic? Im guessing from this post alone your not. Heres a thought cupcake, 24-0 maybe SOMETHING needs to change?....Been walking around in boots and spurs for 20 years now and there a are a handfull of people that wouldn't be except for my "cowboy" ways.
You need to research this further before posting, your coming off looking like an idiot. CCC is working and working well, you just don't understand it becouse it's not written down in front of you. THINK OUTSIDE THE BOX!

 

[ParamedicDiver1]

OMG he has run 24 codes and feels qualified...

Easy there WC Don't know for certain if that is what PoM meant, that is why I was asking for clarification on his post. I know this is a heated discussion, as are most MAJOR changes in medical treatments that go against the standards, but lets all try and refrain from flamming our fellow SBer as well as fellow Medics. I think we have all agreed, by now in this thread, that we need to wait and see the data and then wait some more as AHA, ARC, and other governing bodies review it some more, then see if the standards change.

Remember, the only person who likes change is a baby with a dirty diaper.

Just trying to show the love.

 

[DrSteve]

Actually it's the diaphragm contracting and reducing the air pressure in the lungs that cause respiration. What you are describing is passive airway...an airway that is maintained without conscious control while we are awake. During a cardic arrest the muscle tone of the superior airway is lost and the tongue occludes the oropharynx. Therefore without active airway assistance there is no passage of oxygen. This is precisely why so much attention is paid to obtaining and securing a clear airway.

Isn't this the reason we were all taught to tip the head back, and then tip it back some more?

Finally I'd just like to rant a moment! I do not want to train to work as a paramedic, but I see nothing wrong with learning all I can - hell I took my stress and rescue course for a reason! In the UK I was able to take a full weeks course on first aid (including CPR) which covered a lot of stuff, I expected to be able to find this course in the US (since it was run by the Red Cross) and follow up courses...but apparently the Red Cross doesn't do courses like that. When I took my most recent CPR class in the US and tried to find out where I could go next I found out...Nowhere! Unless I want to spend the time and money training to be a paramedic. What is up with that?

 

[jbd]

Actually it's the diaphragm contracting and reducing the air pressure in the lungs that cause respiration. What you are describing is passive airway...an airway that is maintained without conscious control while we are awake. During a cardic arrest the muscle tone of the superior airway is lost and the tongue occludes the oropharynx. Therefore without active airway assistance there is no passage of oxygen. This is precisely why so much attention is paid to obtaining and securing a clear airway.

I'm well aware of the mechanics of respiration. I also know from experience that when you compress and release the chest of a dead person you get air movement. Trust me, the first few times this happened were somewhat un-nerving. Trying to remember back, I'm not convinced that the tongue occludes the airway in every case especially in the beginning of the event; the time when we are looking to the lay person to initiate care.

 

[jbd]

The big problem I have is that he's convincing actual ALS providers and services to bypass and essentially ignore airway and oxygenation before the facts are in from the field trials and the AHA has had a chance to review.

I think the point is that he is the one gathering the data and facts from the field trials, not the AHA and the other agencies. Who better to conduct the field trials than those in EMS who can make regular observations and comparisons from actual events?
Certainly you wouldn't ask the lay person with little or no experience what their results and observations were.

When the data is in and fully evaluated the results and recommendations will be presented and the standards will either change or they won't.

 

[ParamedicDiver1]

When I took my most recent CPR class in the US and tried to find out where I could go next I found out...Nowhere! Unless I want to spend the time and money training to be a paramedic. What is up with that?

Actually. there are several lower level certifications besides paramedic. Here is Texas we have Emergency Care Attendant (ECA), Emergency Medical Technician (EMT), Emergency Medical Technician - Intermediate (EMT-I), Emergency Medical Technician - Paramedic (EMT-P), and Licensed Paramedic (LP). Each level is more knowledge and skills. An ECA, which is the lowest certification is basically an Advanced First Aid with Oxygen. American Red Cross does offer a course called Emergency Response. It is a comprehensive course designed for training first responders. The course follows the 1995 US DOT First Responder National Standard Curriculum and meets ECC Guidelines. So check into it, there are several route to choose from to expand your knowledge.