Heart Association changes CPR guidelines

[PairofMedics]

Now you claim to be a paramedic instructor? Just wondering, have you broke your self proclaimed two dozen codes yet?
The only effective compressions are those that produce a pulse. Other than dopler, we, that is EMS providers, carry nothing that "shows" an effective compresion.

If there is spontanious circulation, then it isn't PEA now is it? Wave forms do not = effective compressions.

Im kinda old school here, but I try to pass these things along. Treat the Pt not the machine. Just becouse the LP is showing a "perfect" wave form dosen't mean your doing effectve compressions. If they have a pulse, then you are....BLS before ALS, and finaly, treat the person as if it was your family.....

As a matter of fact I have...but only by being dispatched to in progress cardiac arrests. I tend not to run codes because I treat them to prevent the arrest in the first place. Theonly problem with being old school is never graduating. I suppose you'd still give 2 amps of bicarb right off the bat wouldn't you? Read the data and find out why we do things, and patients will benefit from it. Maybe you need a refresher. I offer one...and We can do it on-line if you'd like.

 

[PairofMedics]

I have seen a lot of tubed patients come into the ED with air in the belly. One of the most common mistakes made by medics is incorrect tube placement, or correct tube placement that subsequently became incorrect while the patient was being moved. Suggest a c-collar on every tubed patient to address this.

There is NO guarantee. You must continually reassess and reassess.

OK...lemme clarify. A properly placed, confirmed and maintained ET tube is the gurantee. And capnography will show a dislodged or misplaced tube long before pulse-ox will. The c-coller idea is great and I use it as often as possible. Head beds or rolled towels work as an alternative to keep the head from moving. And commercial devices for security are great too. It's the medics who never reassess, secure the tube with tape and let the head flop about that lose tubes. Bad habits and outdated techniques cause a lot of problems.

 

[PairofMedics]

Now you claim to be a paramedic instructor? Just wondering, have you broke your self proclaimed two dozen codes yet?
The only effective compressions are those that produce a pulse. Other than dopler, we, that is EMS providers, carry nothing that "shows" an effective compresion.

If there is spontanious circulation, then it isn't PEA now is it? Wave forms do not = effective compressions.

Im kinda old school here, but I try to pass these things along. Treat the Pt not the machine. Just becouse the LP is showing a "perfect" wave form dosen't mean your doing effectve compressions. If they have a pulse, then you are....BLS before ALS, and finaly, treat the person as if it was your family.....

Quick lesson. The physical energy you apply to the patient's chest has an electrical equivalent that some monitors can identify in certain augmented leads, and then quantify that energy in the waveform displayed. Deep, wide and consistent waveforms indicate that from an electrical standpoint your compressions are effective. A doppler would confirm mechanical correspondence, but even that may be inneffective if distal circulation is impaired or copletely shunted by that point. Even with ROSC it can take hours and even days for full circulation to return to the extremities. So use EVERYTHING you have at your disposal. Including other opinions.

 

[PairofMedics]

Okay, I have to add my two cents.



In order to prove negligence, there are four universally recognized points that must be addressed.

1. duty to act
2. failure in that duty to act
3. harm
4. proximate cause

If a person is in cardiac arrest, nothing worse can happen to them. They are dead at that point. You can crack ribs (and yes it DOES happen from time to time, especially with incorrect hand placement), lacerate a liver or spleen, puncture a lung or whatever. The patient is pulseless and apneic, they are clinically dead. Therefore, even if you have never been trained in CPR, you can do no harm to that patient, so you are not succeptible to liability. This the way that 911 call centers can give CPR instructions ove the phone to an untrained layperson without fear of the legal ramifications.

********The above only applies to the pulseless and apneic patient!!! Patients who ARE NOT pulseless and apneic can have further harm done to them!*****

The Federal Good Samaritian law DOES NOT superscede state law, as spelled out in the Federal good samaritan law. The Federal Good Samaritan law only applies to AED usage, so State law is more protective anyway.

The following is an excerpt from the National Conference of STate Legislatures
http://www.ncsl.org/programs/health/aed.htm


Capnography is the wave of the future. A person in cardiopulmonary arrest with proper CPR and capnography will show changes in the capnography readings. All of my medics are now using capnography not only in codes, but in breathing difficulty calls as well.

Final point. Someone mentioned that it takes 10-15 seconds for CPR compressions to become effective. This is in fact true. If has been found that fifteen compressions is not enough time for the backpressure to build to a suitable level. In fact, over the phone lay person instructions for CPR are now completely omitting the breathing component.

Follow the local guidelines until they change.

Actually it does..
(a) Liability Protection- A person who donates fire control or fire rescue equipment to a volunteer fire company shall not be liable for civil damages under any State or Federal law for personal injuries, property damage or loss, or death caused by the equipment after the donation.

(b) Exceptions- Subsection (a) does not apply to a person if--

(1) the person's act or omission causing the injury, damage, loss, or death constitutes gross negligence or intentional misconduct; or

(2) the person is the manufacturer of the fire control or fire rescue equipment.

(c) Preemption- This Act preempts the laws of any State to the extent that such laws are inconsistent with this Act, except that notwithstanding subsection (b) this Act shall not preempt any State law that provides additional protection from liability for a person who donates fire control or fire rescue equipment to a volunteer fire company

This act deals primarily with one part of the issue, but all of the Good Samaritan acts have the same language, basically providing that the federal umbrella extands to those wihtout state coverage. The act regarding AEDs is an addition to the original act, brought about by the proliferation of AEDs and the inevitable liability issue they gave birth to. Thankfuly they are now recognized as the standard of care.

 

[Wildcard]

Baby medic, I go back to 6 amps of Bicarb.
Deep wide wave forms indicate nothing but regular compressions, just like PEA. I can compress the belly and get the same thing. When you get a few saves under your belt, then you can talk to me about CPR. By your own admission your at 100% kill rate.

 

[mdjh51]

Actually it does..
(a) Liability Protection- A person who donates fire control or fire rescue equipment to a volunteer fire company shall not be liable for civil damages under any State or Federal law for personal injuries, property damage or loss, or death caused by the equipment after the donation.

As this reads, any individual who provides equipment to volunteer departments is covered. However, I am not a JD. I will forward this discussion on to a JD friend of mine for clarification. Please provide the link to the actual statute

 

[PairofMedics]

Baby medic, I go back to 6 amps of Bicarb.
Deep wide wave forms indicate nothing but regular compressions, just like PEA. I can compress the belly and get the same thing. When you get a few saves under your belt, then you can talk to me about CPR. By your own admission your at 100% kill rate.

Maybe you should have stayed there. I have plenty of saves under my belt, and I don't have to boost my own ego by trying to minimze others' experience. And I'm at 100% save rate, actually. I have yet to lose a cardiac arrest patient where I was responsible for running the code. And I tend not to let my patients get that far in the first place. Now instead of trying to cut me down, why don't you do the mature thing and admit that you don't know everything, and this is a subject you need to learn a little more about. Especially since there have been some advancements since you gave 6 amps of bicarb. We don't even carry that much on the trucks anymore. As an example, look at how pulse oximetry has gone from "The Fifth Vital Sign" to a backseat adjunct whose indications are dodgy at best. Education is one of the basic tenets of being a paramedic, and that certainly includes self education. A healthy debate is wonderful. Hurling petty insults during a discussion is just plain wrong, dude. Play nice. The whole purpose of this forum is to educate each other to mutual benefit. SIX AMPS?????? Geez.

 

[PairofMedics]

As this reads, any individual who provides equipment to volunteer departments is covered. However, I am not a JD. I will forward this discussion on to a JD friend of mine for clarification. Please provide the link to the actual statute

Yep...this was the quickest example I could find, but all versions of the Good Samaritan act include the same language going back to the original. I just have to find it again. Problem is the Congressional database is listing the newest variations instead of the original. I'll keep digging.

 

[simbrooks]

I know i have posted to this thread way back when. But as a moderator i will say this one time - keep it civil or else someone will likely come in with some EMS shears and trim off a few comments.

 

[ParamedicDiver1]

I know i have posted to this thread way back when. But as a moderator i will say this one time - keep it civil or else someone will likely come in with some EMS shears and trim off a few comments.

Haha...nicely put.