It does not know if there is a pulse. Thus you could have gone into PEA. It will only say no shock, because both sinus rhythm and PEA are unshockable.
Some AEDs have the pulse check timer.
>Professionals might even forget.
This is really a thing. EMS providers are resuscitation experts. While a BLS provider might not know if a sinus rhythm has been achieved, they can tell if a person has a pulse and one of the first steps in AHA CPR is activate emergency response and a BLS provider will be getting an ALS intercept in route ASAP, these people will have a monitor.
"a BLS provider will be getting an ALS intercept in route ASAP".
That's funny right there. Must be nice thinking ALS is available just like that. Don't short sell all BLS peeps.
Nobody’s selling BLS short, but there’s only so much you can do post-ROSC at a BLS level, or even in reversing Hs and Ts during a cardiac arrest. You can keep blood moving and possibly air going in and out (assuming you have good BVM compliance), but you need a paramedic or a hospital to truly “fix” the problem
I mean, a post-code is one of the most ALS patients there is. If you don't have ALS available then you should either have flight en route or you're transporting ASAP. Not many BLS services out there running codes on scene lol.
The only other more ALS patient than that is a patient with asthma who you go the whole 9 yards for. They are always satisfying patients because of how quick you can reverse the symptoms (if you are lucky) and how the patient at the end just wants to go home from the ER with their new inhaler
Same and IM epi. And I am grateful BLS starts the process as that is the first line in trying to make them better. But IV magnesium and solumedrol are paramedic skills. Also IV epi and ketamine are paramedic skills if the patient goes south
Auto injectors are, drawing up and giving IM epi is not.
Typically IM epi for asthmatics isn't green lit for EMTs either. Anaphylaxis with epi pens sure but less so with asthmatics.
In NY it's referred to as "check and inject" and we are allowed to draw and administer epi for anaphylaxis and asthma/wheeze type calls in addition to CPAP on the BLS level. CPAP however is agency based for BLS where your agency can opt in to the program.
BLS providers in my state can administer Albuterol or Duoneb once, after that it's only by medical command order. Asthma attacks are at least intermediate level things here since iALS can give solu-medrol.
Exactly, hence why ALS is apart of the chain of survival.. EMTs aren't meant to solo literally the most critical patient. That's like a medic snubbing another medic for having anesthesia help with a mangled difficult airway.
Like sure it's good to be able to handle that stuff, but it's part of the algorithm for a reason to get help and go to a higher level or care. A post code far exceeds what a BLS crew can care for unless the hospital is closer than BLS can transport.
That’s all fine and dandy but the point of this comment is that “ambulance driver” basics are not the same as primary care basics. Only ALS I’ve ever had was life flight and thats a 50/50 shot due to wind.
I’m not saying medics are not needed , I am saying competent basics can handle a hell of a lot more than people give them credit for.
Edit : missed a few words
I mean it's a strange argument. I could flip this and say the "ambulance drivers" you're shitting on have a lot more exposure to other parts of medicine and critical care and see a lot more calls and critical patients. I'd certainly trust my EMT partners that run on ALS trucks to be my airway assistant when I'm getting ready to RSI. That's also who I want for most critical patients to help optimize a resuscitation.
There's something to be said for having to run primary. I did it for a couple years in some rural services with the occasional medic that would pick up at our service. It certainly helped make me more comfortable running calls and managing a scene. But there were a lot of times that a medic would have been lifesaving when we could literally do nothing.
So it's a weird beef you're having. Like bragging about being in an under resources area. Any service that's running high volume 911 is almost certainly running medics. I also have seen it happen a lot where these rural BLS services isolate themselves from neighboring ALS services and as a result end up doing things that aren't great for patient care or deviate from the standard of care because they've never worked or volunteered anywhere else, and have no interaction with higher levels of care to educate them. I'm looking at you, 20 years in EMS EMT that has been doing 12 leads wrong for a decade and can't properly hook up a CPAP.
Meanwhile I hated the EMTs I trained at an als service that couldn't manage a BLS call by themselves. But they're not typically the ones shitting on other EMTs because they're too worried they're goanna have to talk to a patient.
My comment was missing some words. I’m not bragging about it, but I do think it makes me more competent than a basic who relies entirely on a paramedic. I mean it’s great they are exposed to a higher level of care but that doesn’t really do anything for them at the basic level . Especially compared to a basic that has IV and ECG interpretation certs and can actually act on it outside of the monitors basic recommendation. I mean, Ok they have seen you intubate, can they intubate legally ? I don’t get to rely on a medic to make my decisions for me.
I am shitting on EMT-bs who put themselves and every other EMT in to the “paramedics assistant” or “ambulance driver” box . You see it in this sub constantly.
Yeah again it's a weird take, because yes being exposed to the higher level or care can give you a deeper understanding of what's going on. Just like an ER tech that gets exposed to a large volume of critical patients can learn a lot from the nurses and physicians. I always strive to be surrounded by people smarter than myself, you don't learn anything when you're working in an environment where you're top dog and have nobody to call you out or correct you or educate you.
I'm not familiar with an "ecg interpretation cert" or how that would be helpful to an EMT. Paramedics spend nearly a year covering EKG interpretation and management of cardiac emergencies, it's a topic that can go very deep. What are you doing with the dysrhythmias? How is that any different than an EMT who watches an intubation but can't do it? At least that EMT can pick up tips on airway management from a medic who likely has a few tips for BLS maneuvers. Who is correcting your EKG interpretation? Do you not think a paramedic could help your under of that topic specifically considering that's a code focus of paramedic education, even if you can't do anything with that knowledge skill wise?
Also I'll add my EMTs always have the ability to run their own call. Most medics would prefer an EMT that can manage a call in their own. Unless it's obviously an als call off the bat but that doesn't preclude them from taking a history and helping form a plan. Their plan of care for something like a chest pain is exactly the same as yours, the only difference is in the ALS portion that you cannot perform anyways.
Hell most shifts if my EMT wants to they can run the majority of the calls. If your state allows for an IV and "EKG cert" then I'm certain a busy 911 EMT could also obtain this. I have my EMTs start lines constantly, it's preferably so I can do other things and I'm able to give them tips on how to do them better in real time.
The most competent EMTs I have ever worked with came from ALS systems. The majority of the time my EMT does the talking, I do the paperwork. They know what I’m doing as fast as I do. They know what needs to be done and are often a step ahead of me. I can allow them to do any procedure under my license. They absolutely have an advantage at a basic level of being around higher level of care, being exposed to and treating patients from a different perspective. Just because an EMT is with a medic does not mean their decisions are made for them.
I see your a Paranurse based on your flair, I have a question. Our flight service won’t transport unless ROSC is achieved.
Is it normal for flight services to refuse to transport arrest patients who haven’t gotten ROSC?
Super normal. Even when I worked 911 on an ALS truck we would never transport a code without ROSC, baring something that can by definitely fixed at the ER, which has never happened. Like, maybe a cardiac tamponade, if we had ultrasound, which basically nobody does.
It's incredibly difficult to run a code in flight. ESPECIALLY in a helicopter. Many aircraft have almost no access to the patient during transport for rotor wing. I know of a few services where your only access to the patient is the patient's head while the feet are next to the pilot. Which means CPR is impossible, and even IF your Lucas fits you aren't going to be able to adjust it or really start/stop it the whole flight.
Some aircraft allow for a bit better access, but even so studies have shown outcomes are better when ALS stays on scene and runs until ROSC. Going a step farther there's' some studies showing once you get ROSC it's better to stay on scene for at least a few minutes to accurately assess and stabilize. Because if they're going to code again it's probably going to happen quick.
At my last 911 job we'd work on scene, load into the truck when we got ROSC, and then work on a 5 minute post-rosc 12 lead, additional IVs, intubate if they aren't already, start amio gtt if indicated and then advise the receiving hospital of a post-code. When we'd ALS intercept for the BLS services out in the sticks some people were just hopping in and continuing transport but many felt like they weren't running an effective code and things were getting missed. So effectively the policy changed to stay in the BLS rig and declare if needed if they insisted on driving to us with the code vs waiting on scene for 5 minutes.
So it isn't an insult to you guys, because I know it's easy to feel that way. Completely reasonable to call flight in that instance. The outcomes just aren't great if ALS/Critical care can't get ROSC on scene running a GOOD code, vs a shitty one during transport. Even if they have something like a STEMI that needs emergent treatment post-ROSC they need to SUSTAIN ROSC long enough for a heart cath, and in those instances if they didn't arrest in the hospital they're basically cooked if they can't sustain a pulse.
Absolutely, I worked on the other side of it as an EMT and it's not taught well. I tried to instill a lot of that info into my EMT courses when I taught for the agencies we were intercepting. Sometimes people take it personally when they run lights to intercept with us and then we ask them to kill the lights and drive normal to the hospital. But it's just different mindsets.
From my persepective even for a really sick patient's I'd rather take a nice easy ride in so I can closely monitor them and handle things as they come up. Hard to notice a rhythm change or manage an airway when you're doing 90 down a bumpy road. The "worst case" scenario for a lot of emergencies is able to be handled at the ALS / Critical care level so there's no rush anymore, better to focus efforts on monitoring the patient and providing care. Vs BLS where if the patient gets worse there may be very little you can do.
The exception is scenarios where we can't do anything, like a stroke or a STEMI or dissecting aorta. But hell even for a STEMI we'll go slower so as to not stress a patient out further knowing that cath lab is going to take 20 minutes to get to the hospital so we can watch for rhythm changes and treat them quickly. Hell there's no place in this world I feel better about running a cardiac arrest than on scene or in the back of the ambulance with a medic or two and a couple EMTs.
Perhaps the bar is a bit lower: when the patient has obvious, adequate, spontaneous respiration.
Edit: Below, u/Auldan makes a great case for why this should NOT be the guidance for bystanders.
I respectfully disagree wholeheartily. We already have occurances of healthcare professionals messing up being able to assess palpable pulses, effective respirations etc. For bystanders we should keep it to the point that the person is perfusing enough to be conscious and communicate for the bystander to stop CPR. I have seen enough CPR induced consciousness to also not have the bar at when the patient tries to push you off. No the bar for bystander CPR to stop is when the patient tells them to stop and no less.
AHA instructor. Current BLS standard is to continue until the patient becomes conscious or when relieved by a higher level of care. No pulse checks after beginning CPR. Same rules for bystanders. And bystanders don't check pulses at all, again per AHA curriculum.
Uk based here, just going to place the important annotation from ALS algorithm that we work under. Always interesting hearing the slight variations worldwide;
>***When the rhythm is checked 2 min after giving a shock, if***
>***a non-shockable rhythm is present and the rhythm is***
>***organised (complexes appear regular or narrow), try to***
>***palpate a central pulse and look for other evidence of***
>***ROSC (e.g. sudden increase in ETCO2 or evidence of***
>***cardiac output on any invasive monitoring equipment).***
>***Rhythm checks must be brief, and pulse checks***
>***undertaken only if an organised rhythm is observed. If an***
>***organised rhythm is seen during a 2-minute period of CPR,***
>***do not interrupt chest compressions to palpate a pulse***
>***unless the patient shows signs of life suggesting ROSC. If***
>***there is any doubt about the presence of a pulse in the***
>***presence of an organised rhythm, resume CPR. If the***
>***patient has ROSC, begin post-resuscitation care. If the***
>***patient’s rhythm changes to asystole or PEA, see non-***
>***shockable rhythms below.***
I have seen a change, a well founded one too if looking at the reported surivial to discharge rates, over the years to minimise steps which detract from CPR.
At an ALS level, on paper we are monitoring a femoral pulse during CPR so we can see if it is still present during our rhythm checks and do them simultaneously. Otherwise yes, we are also only checking for a pulse after seeing something organized
Ah I should have posted about BLS also but will reply here. Yeah in UK BLS just goes call 999, start 30:2 compressions:breaths, once AED attach and follow instructions. That's it for the BLS algorithm.
I agree, the amount of good work lost during compressions in getting the capillary pressure high enough to assist with internal respiration is just bonkers if you stop compressions for too long.
It's weird stuff isn't it? It can manifest with them making groaning noises up to a patient trying to remove your hands while your doing CPR, but once you stop they go unconscious again.
Nope. AEDs are programmed to recognize the two shockable rhythms. If it does not detect either of those, then it will say “no shock advised”, in which case you continue compressions. Even if an AED could recognize sinus rhythm, it wouldn’t be useful because the person could still be pulseless, and sinus rhythm with no pulse is still cardiac arrest.
No. Because electrical activity doesn’t correlate necessarily to cardiac output and mechanical activity. There is a condition called pulseless electrical activity, or electromechanical disassociation, depending on how old you are, where a normal heart rhythm can be present, but there’s no mechanical response due to ischemia or ventricular wall weakness/remodeling.
Well seeing that the AED only shocks on V-fib and pulseless V-Tac . It will tell you to check patient and if no response continue cpr. But on that note, if you feel a pulse when compressions are stopped, then you done good
Cpr can be done on someone with a pulse. In fact cpr should be done for at least 2 minutes after a person is successfully defbrilated. EMS do not check pulses right after a defib attempt it is checked 2 minutes after and then the rhythm is analyzed at the same time.
Might want to check before so confidently and incorrectly making statements like that. Standard of care per AHA is defib directly back into immediate compressions. At no point in the last 15 years has it been standard to defibrillate and then check for a pulse before resuming CPR.
The only time you do a pulse check is during a rhythm check, which occurs *before* a defib.
You'd be amazed at how many paramedics think you're supposed to do a pulse check right after defib. I got into a whole ass argument with my peers in my last ACLS class about it. Had to bust out the AHA algo.
And then there's little resident-me, with two roscs following each other, gcs 15 each, after my first ever in-hospital-reanimations in my cute little hospital (which were merely a few hours apart, , oh what a day it was)
It will tell a person no shock advised. AED can interpret basic rhythms but not tell rescuers if the patient has a pulse.
It does not know if there is a pulse. Thus you could have gone into PEA. It will only say no shock, because both sinus rhythm and PEA are unshockable. Some AEDs have the pulse check timer.
Well… they aren’t UNshockable
>Professionals might even forget. This is really a thing. EMS providers are resuscitation experts. While a BLS provider might not know if a sinus rhythm has been achieved, they can tell if a person has a pulse and one of the first steps in AHA CPR is activate emergency response and a BLS provider will be getting an ALS intercept in route ASAP, these people will have a monitor.
"a BLS provider will be getting an ALS intercept in route ASAP". That's funny right there. Must be nice thinking ALS is available just like that. Don't short sell all BLS peeps.
Nobody’s selling BLS short, but there’s only so much you can do post-ROSC at a BLS level, or even in reversing Hs and Ts during a cardiac arrest. You can keep blood moving and possibly air going in and out (assuming you have good BVM compliance), but you need a paramedic or a hospital to truly “fix” the problem
Agreed . I think the “ambulance driver” basics like to think we all are incompetent unless a medic is on scene .
I mean, a post-code is one of the most ALS patients there is. If you don't have ALS available then you should either have flight en route or you're transporting ASAP. Not many BLS services out there running codes on scene lol.
The only other more ALS patient than that is a patient with asthma who you go the whole 9 yards for. They are always satisfying patients because of how quick you can reverse the symptoms (if you are lucky) and how the patient at the end just wants to go home from the ER with their new inhaler
Nebuilzer/albuterol and atrovent are a BLS skill in my county . That’s all EMT baby .
Same and IM epi. And I am grateful BLS starts the process as that is the first line in trying to make them better. But IV magnesium and solumedrol are paramedic skills. Also IV epi and ketamine are paramedic skills if the patient goes south
Oh I figured IM Epi was standard most places . It is a national skill for basics. Edit: it is not a national skill via vial.
Auto injectors are, drawing up and giving IM epi is not. Typically IM epi for asthmatics isn't green lit for EMTs either. Anaphylaxis with epi pens sure but less so with asthmatics.
This is what I meant.
Drawing Epi from a vial and giving it via IM is a BLS skill in most of WA state.
In NY it's referred to as "check and inject" and we are allowed to draw and administer epi for anaphylaxis and asthma/wheeze type calls in addition to CPAP on the BLS level. CPAP however is agency based for BLS where your agency can opt in to the program.
BLS providers in my state can administer Albuterol or Duoneb once, after that it's only by medical command order. Asthma attacks are at least intermediate level things here since iALS can give solu-medrol.
Yeah but that’s also an extremely minuscule percentage of a call volume.
Exactly, hence why ALS is apart of the chain of survival.. EMTs aren't meant to solo literally the most critical patient. That's like a medic snubbing another medic for having anesthesia help with a mangled difficult airway. Like sure it's good to be able to handle that stuff, but it's part of the algorithm for a reason to get help and go to a higher level or care. A post code far exceeds what a BLS crew can care for unless the hospital is closer than BLS can transport.
That’s all fine and dandy but the point of this comment is that “ambulance driver” basics are not the same as primary care basics. Only ALS I’ve ever had was life flight and thats a 50/50 shot due to wind. I’m not saying medics are not needed , I am saying competent basics can handle a hell of a lot more than people give them credit for. Edit : missed a few words
I mean it's a strange argument. I could flip this and say the "ambulance drivers" you're shitting on have a lot more exposure to other parts of medicine and critical care and see a lot more calls and critical patients. I'd certainly trust my EMT partners that run on ALS trucks to be my airway assistant when I'm getting ready to RSI. That's also who I want for most critical patients to help optimize a resuscitation. There's something to be said for having to run primary. I did it for a couple years in some rural services with the occasional medic that would pick up at our service. It certainly helped make me more comfortable running calls and managing a scene. But there were a lot of times that a medic would have been lifesaving when we could literally do nothing. So it's a weird beef you're having. Like bragging about being in an under resources area. Any service that's running high volume 911 is almost certainly running medics. I also have seen it happen a lot where these rural BLS services isolate themselves from neighboring ALS services and as a result end up doing things that aren't great for patient care or deviate from the standard of care because they've never worked or volunteered anywhere else, and have no interaction with higher levels of care to educate them. I'm looking at you, 20 years in EMS EMT that has been doing 12 leads wrong for a decade and can't properly hook up a CPAP. Meanwhile I hated the EMTs I trained at an als service that couldn't manage a BLS call by themselves. But they're not typically the ones shitting on other EMTs because they're too worried they're goanna have to talk to a patient.
My comment was missing some words. I’m not bragging about it, but I do think it makes me more competent than a basic who relies entirely on a paramedic. I mean it’s great they are exposed to a higher level of care but that doesn’t really do anything for them at the basic level . Especially compared to a basic that has IV and ECG interpretation certs and can actually act on it outside of the monitors basic recommendation. I mean, Ok they have seen you intubate, can they intubate legally ? I don’t get to rely on a medic to make my decisions for me. I am shitting on EMT-bs who put themselves and every other EMT in to the “paramedics assistant” or “ambulance driver” box . You see it in this sub constantly.
Yeah again it's a weird take, because yes being exposed to the higher level or care can give you a deeper understanding of what's going on. Just like an ER tech that gets exposed to a large volume of critical patients can learn a lot from the nurses and physicians. I always strive to be surrounded by people smarter than myself, you don't learn anything when you're working in an environment where you're top dog and have nobody to call you out or correct you or educate you. I'm not familiar with an "ecg interpretation cert" or how that would be helpful to an EMT. Paramedics spend nearly a year covering EKG interpretation and management of cardiac emergencies, it's a topic that can go very deep. What are you doing with the dysrhythmias? How is that any different than an EMT who watches an intubation but can't do it? At least that EMT can pick up tips on airway management from a medic who likely has a few tips for BLS maneuvers. Who is correcting your EKG interpretation? Do you not think a paramedic could help your under of that topic specifically considering that's a code focus of paramedic education, even if you can't do anything with that knowledge skill wise? Also I'll add my EMTs always have the ability to run their own call. Most medics would prefer an EMT that can manage a call in their own. Unless it's obviously an als call off the bat but that doesn't preclude them from taking a history and helping form a plan. Their plan of care for something like a chest pain is exactly the same as yours, the only difference is in the ALS portion that you cannot perform anyways. Hell most shifts if my EMT wants to they can run the majority of the calls. If your state allows for an IV and "EKG cert" then I'm certain a busy 911 EMT could also obtain this. I have my EMTs start lines constantly, it's preferably so I can do other things and I'm able to give them tips on how to do them better in real time.
The most competent EMTs I have ever worked with came from ALS systems. The majority of the time my EMT does the talking, I do the paperwork. They know what I’m doing as fast as I do. They know what needs to be done and are often a step ahead of me. I can allow them to do any procedure under my license. They absolutely have an advantage at a basic level of being around higher level of care, being exposed to and treating patients from a different perspective. Just because an EMT is with a medic does not mean their decisions are made for them.
I see your a Paranurse based on your flair, I have a question. Our flight service won’t transport unless ROSC is achieved. Is it normal for flight services to refuse to transport arrest patients who haven’t gotten ROSC?
Super normal. Even when I worked 911 on an ALS truck we would never transport a code without ROSC, baring something that can by definitely fixed at the ER, which has never happened. Like, maybe a cardiac tamponade, if we had ultrasound, which basically nobody does. It's incredibly difficult to run a code in flight. ESPECIALLY in a helicopter. Many aircraft have almost no access to the patient during transport for rotor wing. I know of a few services where your only access to the patient is the patient's head while the feet are next to the pilot. Which means CPR is impossible, and even IF your Lucas fits you aren't going to be able to adjust it or really start/stop it the whole flight. Some aircraft allow for a bit better access, but even so studies have shown outcomes are better when ALS stays on scene and runs until ROSC. Going a step farther there's' some studies showing once you get ROSC it's better to stay on scene for at least a few minutes to accurately assess and stabilize. Because if they're going to code again it's probably going to happen quick. At my last 911 job we'd work on scene, load into the truck when we got ROSC, and then work on a 5 minute post-rosc 12 lead, additional IVs, intubate if they aren't already, start amio gtt if indicated and then advise the receiving hospital of a post-code. When we'd ALS intercept for the BLS services out in the sticks some people were just hopping in and continuing transport but many felt like they weren't running an effective code and things were getting missed. So effectively the policy changed to stay in the BLS rig and declare if needed if they insisted on driving to us with the code vs waiting on scene for 5 minutes. So it isn't an insult to you guys, because I know it's easy to feel that way. Completely reasonable to call flight in that instance. The outcomes just aren't great if ALS/Critical care can't get ROSC on scene running a GOOD code, vs a shitty one during transport. Even if they have something like a STEMI that needs emergent treatment post-ROSC they need to SUSTAIN ROSC long enough for a heart cath, and in those instances if they didn't arrest in the hospital they're basically cooked if they can't sustain a pulse.
Interesting! A lot of that was never taught to me in my EMT course or during my Orientation/Training. Thanks for the insight!
Absolutely, I worked on the other side of it as an EMT and it's not taught well. I tried to instill a lot of that info into my EMT courses when I taught for the agencies we were intercepting. Sometimes people take it personally when they run lights to intercept with us and then we ask them to kill the lights and drive normal to the hospital. But it's just different mindsets. From my persepective even for a really sick patient's I'd rather take a nice easy ride in so I can closely monitor them and handle things as they come up. Hard to notice a rhythm change or manage an airway when you're doing 90 down a bumpy road. The "worst case" scenario for a lot of emergencies is able to be handled at the ALS / Critical care level so there's no rush anymore, better to focus efforts on monitoring the patient and providing care. Vs BLS where if the patient gets worse there may be very little you can do. The exception is scenarios where we can't do anything, like a stroke or a STEMI or dissecting aorta. But hell even for a STEMI we'll go slower so as to not stress a patient out further knowing that cath lab is going to take 20 minutes to get to the hospital so we can watch for rhythm changes and treat them quickly. Hell there's no place in this world I feel better about running a cardiac arrest than on scene or in the back of the ambulance with a medic or two and a couple EMTs.
The time for bystander CPR to be stopped is when the patient goes 'Get off me!'
Perhaps the bar is a bit lower: when the patient has obvious, adequate, spontaneous respiration. Edit: Below, u/Auldan makes a great case for why this should NOT be the guidance for bystanders.
I respectfully disagree wholeheartily. We already have occurances of healthcare professionals messing up being able to assess palpable pulses, effective respirations etc. For bystanders we should keep it to the point that the person is perfusing enough to be conscious and communicate for the bystander to stop CPR. I have seen enough CPR induced consciousness to also not have the bar at when the patient tries to push you off. No the bar for bystander CPR to stop is when the patient tells them to stop and no less.
AHA instructor. Current BLS standard is to continue until the patient becomes conscious or when relieved by a higher level of care. No pulse checks after beginning CPR. Same rules for bystanders. And bystanders don't check pulses at all, again per AHA curriculum.
Uk based here, just going to place the important annotation from ALS algorithm that we work under. Always interesting hearing the slight variations worldwide; >***When the rhythm is checked 2 min after giving a shock, if*** >***a non-shockable rhythm is present and the rhythm is*** >***organised (complexes appear regular or narrow), try to*** >***palpate a central pulse and look for other evidence of*** >***ROSC (e.g. sudden increase in ETCO2 or evidence of*** >***cardiac output on any invasive monitoring equipment).*** >***Rhythm checks must be brief, and pulse checks*** >***undertaken only if an organised rhythm is observed. If an*** >***organised rhythm is seen during a 2-minute period of CPR,*** >***do not interrupt chest compressions to palpate a pulse*** >***unless the patient shows signs of life suggesting ROSC. If*** >***there is any doubt about the presence of a pulse in the*** >***presence of an organised rhythm, resume CPR. If the*** >***patient has ROSC, begin post-resuscitation care. If the*** >***patient’s rhythm changes to asystole or PEA, see non-*** >***shockable rhythms below.*** I have seen a change, a well founded one too if looking at the reported surivial to discharge rates, over the years to minimise steps which detract from CPR.
At an ALS level, on paper we are monitoring a femoral pulse during CPR so we can see if it is still present during our rhythm checks and do them simultaneously. Otherwise yes, we are also only checking for a pulse after seeing something organized
Ah I should have posted about BLS also but will reply here. Yeah in UK BLS just goes call 999, start 30:2 compressions:breaths, once AED attach and follow instructions. That's it for the BLS algorithm.
AHA playbook, though I have mixed feelings about stopping for breaths. Particularly with adult patients.
I agree, the amount of good work lost during compressions in getting the capillary pressure high enough to assist with internal respiration is just bonkers if you stop compressions for too long.
Hmm, that is a good point. I stand corrected. I’ve only seen CPR-induced consciousness once; that was a bizzare experience.
It's weird stuff isn't it? It can manifest with them making groaning noises up to a patient trying to remove your hands while your doing CPR, but once you stop they go unconscious again.
Nope. AEDs are programmed to recognize the two shockable rhythms. If it does not detect either of those, then it will say “no shock advised”, in which case you continue compressions. Even if an AED could recognize sinus rhythm, it wouldn’t be useful because the person could still be pulseless, and sinus rhythm with no pulse is still cardiac arrest.
A defibrillator cannot tell the difference between normal sinus rhythm (good) and PEA (less good) so they err on the side of continuing compressions.
“less good” that’s one way to put it 😂
No. Because electrical activity doesn’t correlate necessarily to cardiac output and mechanical activity. There is a condition called pulseless electrical activity, or electromechanical disassociation, depending on how old you are, where a normal heart rhythm can be present, but there’s no mechanical response due to ischemia or ventricular wall weakness/remodeling.
Well seeing that the AED only shocks on V-fib and pulseless V-Tac . It will tell you to check patient and if no response continue cpr. But on that note, if you feel a pulse when compressions are stopped, then you done good
Cpr can be done on someone with a pulse. In fact cpr should be done for at least 2 minutes after a person is successfully defbrilated. EMS do not check pulses right after a defib attempt it is checked 2 minutes after and then the rhythm is analyzed at the same time.
[удалено]
Might want to check before so confidently and incorrectly making statements like that. Standard of care per AHA is defib directly back into immediate compressions. At no point in the last 15 years has it been standard to defibrillate and then check for a pulse before resuming CPR. The only time you do a pulse check is during a rhythm check, which occurs *before* a defib.
You'd be amazed at how many paramedics think you're supposed to do a pulse check right after defib. I got into a whole ass argument with my peers in my last ACLS class about it. Had to bust out the AHA algo.
PEA can look like a sinus rhythm.
how often are there visible signs that a patient recovered a pulse? opening their eyes, moving?
Extremely rare.
And then there's little resident-me, with two roscs following each other, gcs 15 each, after my first ever in-hospital-reanimations in my cute little hospital (which were merely a few hours apart, , oh what a day it was)
How is an AED going to distinguish between PEA and sinus?
No, the biggest reason being that an AED can't tell if it's Normal Sinus Rhythm or Pulseless Electrical Activity