New ACLS????

[BabyDuck]

yep, i did my update a month ago. very weird.

y'all remember 'shock shock shock, everybody shock. big shock, little shock, everybody shock'? gone, all gone...

 

[erparamedic]

Ya, it was an unusual class today. Usualy it's medics and nurses. Today a baby ( I swear sh is 12) RT, two nurses and three docs, oh ya, and me the lone medic in the class. Myself and the docs were all shaking our heads.

I am also a medic, and had 2 cardiologists in my last ACLS class. (The hospital that I work at has a seperate and specialized Heart Hospital right next door... the ACLS class was at the Heart Hosp.). They (the docs) said that the reason for doing 2 minutes of compression, prior to shocking (in unwitnessed arrests) is:

When the person went down, they took a *last breath*. That "good air" has been sitting, unused in the lungs and cardiovascular system. The brain has been without circulation and oxygen for "xyz" minutes. The theory, is supposed to be that by first performing CPR for 2 minutes, it will circulate good oxygen to the brain, that is much in need of it.

Of course, in years past, it was drilled into our brains that the cardiac arrest is an "electrical malfunction" of the heart and to shock first. There will always be changes in guidelines.

You know... one thing will remain....

People will suffer from cardiac arrest. We will always have guidelines by which to treat. I believe, (the latest stats I heard) was something like 2% of cardiac arrest patients will be considered a "save".... in which they will have a return of heartbeat, with a perfusing rhythm, and make it out of the ER and into the ICU... but only 2% of those "saves" will leave the hospital alive. Out of those that do leave the hospital, alive, what kind of quality of life do they "typically" have? Generally, not a good one, considering there is almost always a degree of anoxic brain injury. Of course there's always a few that live thru it all and lead a normal life after... but those are, what I'd consider, true miracles.

I believe that the latest change in the ACLS guidelines is another "trial" (for lack of better words), to see if we can improve, not only the saves, but the quality of life that those "saves" will have.

That's just my take on the whole thing.

 

[Wildcard]

Clearly what we have been doing dosn't work so well but I realy have to question if some of this is any better if not worse? Two minutes is a long time for someone to slip from fib into asystole while were pumping on therm.

 

[rongoodman]

I think the rationale for continuing CPR following the shock is that even if the fib is converted, the initial rhythm will likely be non-perfusing, so taking time for an immediate pulse check won't do any good. (It struck me during this last update that I've been taking these courses for 20 years--lots of changes in that time, both in the medicine and the course structure.)

 

[erparamedic]

Clearly what we have been doing dosn't work so well but I realy have to question if some of this is any better if not worse? Two minutes is a long time for someone to slip from fib into asystole while were pumping on therm.

Very true, and once in asystole or PEA, it's nearly impossible to resuscitate.

 

[Wildcard]

I think the rationale for continuing CPR following the shock is that even if the fib is converted, the initial rhythm will likely be non-perfusing, so taking time for an immediate pulse check won't do any good. (It struck me during this last update that I've been taking these courses for 20 years--lots of changes in that time, both in the medicine and the course structure.)

Thats where I have the problem. Real life codes DO have perfusing pulses many time after C/V, why keep pumping and risk damage?..I finnished up with 100% on both portions of the test but I still don't like it.

 

[Brian1968]

yep, i did my update a month ago. very weird.

y'all remember 'shock shock shock, everybody shock. big shock, little shock, everybody shock'? gone, all gone...

Now you've gone and gotten me feeling all nostalgic.

 

[Dive-aholic]

...When the person went down, they took a *last breath*. That "good air" has been sitting, unused in the lungs and cardiovascular system. The brain has been without circulation and oxygen for "xyz" minutes. The theory, is supposed to be that by first performing CPR for 2 minutes, it will circulate good oxygen to the brain, that is much in need of it...

Every code I've witnessed, the patient let all the "good air" out in a big snoring exhalation. That doesn't leave much left to circulate!

 

[Wildcard]

Every code I've witnessed, the patient let all the "good air" out in a big snoring exhalation. That doesn't leave much left to circulate!

Ya would think that one of these "research docs" would have ever realy been on a code or two but it becomes more evident every day they have not.... I rember a research paper done by some doc in LA who said she "personally trained" a group of paramedics on pedi intubation. There stats were, well, not good. Her conclusion which was published and accepted was that paramedics couldn't intubate kids! ***? Kids are a no miss situation....GGGggrrrr Docs with no windows in there office....

 

[Dive-aholic]

I don't think there are many docs that practice and publish. They either do one or the other. Unfortunately, most of the docs that publish haven't had much, if any, recent practice.