C.P.R. ?
just wondering how many take the training along with basic first aid . i am off to class a 8:00 this morning
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Used to teach it. It works.
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quote:Originally posted by KEVD18
jwb:
on your mils call:
most prehospital providers CANT access dialysis ports, picc lines, central lines, porta caths or any other acces devices i may have forgotten. we arent trained to do it so if we need to give meds, we have to start a line. you can bump noses all you like but in that case your wrong. there are reasons why we sometimes "stay and play" versus "load and go". for example, they need an iv badly becuase im knowim going to be giving meds on this run. i take a quick look at the patient and see they are elderly, look dehydrated, maybe they have a av shunt in one arm so i cant start a line there. basically everything adds up to this is going to be a tough stick. i can a) do the stick in a quite, well lit, stationary setting; or b) bouncing down the road where im much more likely to miss. this situation is one where i will stay and play. cardiac arrests get a line/tube/shock and 2 rounds of drugs if at all possible prior to departure as a general rule, exceptions do apply. again, i much prefer attempting to intubate somebody in a quite, well lit, stationary setting. while its not always possible, when it is, bet you buttocks im taking advantage. while the patient and the patients next of kin or power of attorney have the right to refuse medical care offered by ems, nobody else has the right to do that for them. remember, you called the ambulance because they need medical care. if all they needed was a ride to the hospital, you should have called a cab or driven them your self. butting heads with the emt's/medics on scene doesnt do anybody any good. in fact, in ma it can get you arrested.
on your living will:
check your local prehospital protocols. in ma, the ONLY valid form of paperwork to prevent cpr is a mass oems cc/dnr form. a living will, a notarized bar napkin, a tatoo on your chest. none of it is any good. one form, or the bracelet that comes with it. since that decision doesnt come lightly, im sure you researched it thoroughly; but i have dealt with patients who were unaware that their living will didnt cover them.
as i stated in my previous post she was a dialysis patient. she could not breath. even if the medic could have established a IV it would have only made matters worse. in case you dont know that would be adding more fluid in her body which is the problem for her having a breathing problem. and as far as you claim you are good sticking, that is the reason for the port.i watched the IV team at the hospital TRY to stick her before the port was placed and it took them about 10 minutes. in our area we only have volunteer fire & ems when we called 911 we expected our company in town (no medics) they scratched the call, a paid company came with a medic. the above information was told to them. you need to give her oxygen and load and go.as far as me getting arrested, i dont think so, when my wife was there and looked at the medic and asked him if he had a damn hearing problem.you also remind me of a medic that tried to stick me. i told him he would have a tough time he asured he how good he was i told him he had one chance, well he BENT the needle0 -
As required for NYS high school coaches we initally have to take a full course in CPR, First Aid , Child Abuse Recognition, How to Use Defibulator and others, then we do refresher courses once a year. 0 -
I sleep with an EMT, does that count? [8D] 0 -
A lot of you guys remind me of myself when I was a rookie EMT. I wanted to become a CPR instructor, I wanted to same some lives with CPR.
The Red Cross representative would come by and get us all sparked up. I really believed in CPR.
I worked at an EMS that had three full time ambulances, all were advanced life support. Some ambulances had two paramedics, some had one paramedic and one basic. We had 14 paramedics and 4 basics, full time, plus a director and assistant director, both paramedics. We were fully ACLS certified and we had the latest in heart monitors and cardiac drugs. We were a progressive EMS.
Usually when there was a code in the field you would get a backup, so we usually worked a code with 3 paramedics and one basic, or with 4 paramedics. Sometimes the director would swing by to help. Many codes in the field were worked with 5 paramedics.
Well I had been there a year, as a basic EMT. I had worked codes on 80 year old ladies at the nursing home. I had worked codes on 65 year old truck drivers at the grocery store. I had worked codes on 20 year old girls injured in car wrecks. I had done lots of CPR, since I couldn't intubate or defibrillate yet. I had worked about 50 codes in that year, and every single patient had died. Some had made it to the ICU with a pulse, but not one of them had walked out of the hospital.
I began to get very skeptical about CPR. I suspected that the Red Cross was fudging the statistics big time.
In another year I gained my Paramedic certificate and I worked in EMS for over 11 more years after that. I was intubating and defibrillating patients, and administering cardiac drugs. We were a hospital based EMS and our barracks were out in the parking lot 200 feet from the ER, so I worked a lot of codes in the ER and up on the floor. I had a reputation for being good with the ET tube and I did a half dozen or so intubations in the ER. It happened more than once that the phone went off in our barracks at 2am, an ER nurse was calling saying the ER doc wanted "That big Allen Griggs to come over" and do an intubation. Of course I was glad to oblige.
Sure, I had some saves on codes. But these were all on people who were already in medical care when their heart stopped beating. The saves I saw were people who were defibrillated soon after they went into cardiac arrest, and who only had CPR done for a minute or so. I also saw a few cardioversions by drugs, one time by drugs in the ET tube! That was pretty cool.
I worked on 500 codes, more or less, and less than ten of my patients lived to walk out of the hospital. So little CPR was done on those that it was hard to tell whether it did any good or not.
What DOES work is defibrillation, when it is administered within a few minutes of the cardiac arrest.
If you are at a birthday party, and old 75 year old grandad drops of a heart attack, and you think you are going to do CPR for ten minutes and keep him alive until the medics get there, you are almost certainly wrong. His heart stopped, and he is on the ground, and he is DEAD, and all the king's horses and all the kings men can't put him back together again.
I am sure that y'all have read stories in the paper, "Coach saves basketball player with CPR." A 17 year old basketball player collapsed during a game and the coach administered CPR. The paramedics came and took the kid to the hospital, and he lived. That story goes into the Red Cross' stats as a "CPR save."
I am very suspicious of a story like that. In most cases I doubt the kid was ever in cardiac arrest, more likely, he was having a seizure and never needed CPR, and is in fact lucky that the well meaning, zealous, but ignorant coach did not kill him. It is not so easy to find a pulse if you are inexperienced in doing so.
Y'all do know that CPR can fracture ribs and kill a person, don't you?
KEVD you sound like an experienced paramedic. How long have you been a paramedic? About how many codes have you worked on? Think carefully, how many of your patients have lived to walk out of the hospital?
I got out of the medical field in 1993. Maybe there have been some big advancements that have increased the success rate of CPR, if so I would like to hear about it.
In about ninety nine percent of the cases in which I participated in CPR, it amounted to no more than desecration of a corpse.
My fellow medics shared my view on CPR and we were no gang of dummies. Three of my medic buddies went on to become RNs, one went to veterinarian school, and my best friend was a paramedic who had a masters degree in biology and went on to medical school in Augusta and became a PA. If you asked any of them about CPR they would tell you the same thing I am telling you.0 -
I came in second in my "combat lifesaver" class, but it's been a while... I let her get honor grad. 0 -
Wow! Lots of good comments here. I have been in EMS for 13 years...an EMT since 1995 and a Paramedic since 2003. I have worked a bunch of codes and like Allen Griggs says....CPR is over-rated. What really works best for a cardiac arrest is EARLY DEFIBRILLATION. That's why I think AED's should be available everywhere. Allen is right about sometimes getting a pulse back on patients that have gone into cardiac arrest....Yes, you got a pulse back on that 85 year old patient who will go to ICU and live in a vegetative state for 2-3 more days, but what have you accomplished for the patient? Granted, we have given the family "time" to be with their loved one for a few more days.
The service I work for has bought several new devices called an Auto-Pulse (street name---The Geezer Squeezer). It actually does chest compressions instead of doing manual CPR. Supposedly, CPR performed by a trained person will circulate about 15% of the blood volume. The Auto-Pulse will circulate 85% of the blood volume. Plus, it frees up one of the crew members from CPR and allows them to be doing other stuff (intubation, drug administration, etc).
Just a "war story" here, but the first cardiac arrest I worked as a medic....We got a call for an arrest in the parking lot of a doctor's office. Arrive on scene and see two doctors performing CPR. Patient is in V-Fib. Shocked the patient and he converted after one shock. I intubated him and started an IV. Transported to ER and patient was flown to another hospital about 60 miles away in nashville. Five days later, the patient walks out of the hospital with no complications. That was a "good save".0 -
as i have said before and will continue to say until it changes for i am for to superstitious to put the cart before the horse:
i am but a humble paramedic INTERN. while someday soon i will me a medic, not yet. to answer your question allen, i have 5 years of experience as an EMT in a very busy urban system. 2 of those years were on a medic truck, plus a hundred ot shifts since. my personal code count, hell maybe a hundred maybe twice that. i dont count. success rate? dismal as expected. the stats i quote for cardiac arrest come from the american heart association emergency cardiac committee; and they reflect codes worked around the world in system with transport times from 2 mins to 2 hours. the newest drugs or procedures to the oldest. while your record or mine may not fall into the average, its still the average.
you are quite right though. cpr does not bring people back. it buys time till advanced care. now for the basketball player. picture this, that kid just developed a total heart block. kid drops and bradys out(heartbeat slows until it stops). now, the only thing wrong with this kid is the conduction system in his heart has failed. he needs a pacemaker. cpr will keep him alive till the medics get there to put him on the pacer. then he gets to the or for an implant. id say that pretty much a save. not saying there have been cases of unnecessary cpr, but there have been legit cpr saves. i know. that how a friend of mine got his pacemaker. he's 22.
jwb: im aware she was a dialysis patient, as that was the central theme of my post. we cant use those accesses. besides, establishing iv access isnt just for adding fluid, it can also be used for removing and/or redistributing fluid(lasix/mannitol) and giving respiratory drugs(terbutaline, solumedrol, the list goes on). i auure you, when i treat a patient, i act in the patient's best interest. not the families. and you can be arrested for interfering with emergency medical care, at least in Massachusetts.
anyway, i had a conversation with another member offline about trying to educate people who don't want to be educated and what a hopeless battle that can be so i quit. think what ever you like. your profile says your in w. Virginia. I'm in Boston. i doubt we'll ever some across each other professionally; and from your ignorance and unwillingness to learn from people who actually know more than you about something, I'm ok with that.
your humble medic intern,
kevd.0 -
Question for EMS. I worked for a medical company several years ago. We sold a product called Revive-it(sp). It was a backboard with straps that would do chest compressions. It was bought by Zoll. I have lost touch with the company. I was wondering if it ever caught on? 0 -
quote:Originally posted by KEVD18
as i have said before and will continue to say until it changes for i am for to superstitious to put the cart before the horse:
i am but a humble paramedic INTERN. while someday soon i will me a medic, not yet. to answer your question allen, i have 5 years of experience as an EMT in a very busy urban system. 2 of those years were on a medic truck, plus a hundred ot shifts since. my personal code count, hell maybe a hundred maybe twice that. i dont count. success rate? dismal as expected. the stats i quote for cardiac arrest come from the american heart association emergency cardiac committee; and they reflect codes worked around the world in system with transport times from 2 mins to 2 hours. the newest drugs or procedures to the oldest. while your record or mine may not fall into the average, its still the average.
you are quite right though. cpr does not bring people back. it buys time till advanced care. now for the basketball player. picture this, that kid just developed a total heart block. kid drops and bradys out(heartbeat slows until it stops). now, the only thing wrong with this kid is the conduction system in his heart has failed. he needs a pacemaker. cpr will keep him alive till the medics get there to put him on the pacer. then he gets to the or for an implant. id say that pretty much a save. not saying there have been cases of unnecessary cpr, but there have been legit cpr saves. i know. that how a friend of mine got his pacemaker. he's 22.
jwb: im aware she was a dialysis patient, as that was the central theme of my post. we cant use those accesses. besides, establishing iv access isnt just for adding fluid, it can also be used for removing and/or redistributing fluid(lasix/mannitol) and giving respiratory drugs(terbutaline, solumedrol, the list goes on). i auure you, when i treat a patient, i act in the patient's best interest. not the families. and you can be arrested for interfering with emergency medical care, at least in Massachusetts.
anyway, i had a conversation with another member offline about trying to educate people who don't want to be educated and what a hopeless battle that can be so i quit. think what ever you like. your profile says your in w. Virginia. I'm in Boston. i doubt we'll ever some across each other professionally; and from your ignorance and unwillingness to learn from people who actually know more than you about something, I'm ok with that.
your humble medic intern,
kevd.
i am not as ignorant as what you may think. but there again i could give a rats ass what you think. i was a national registered EMT for years.let me tell you something sir the smartest doctors in the world have made mistakes.what you learn from a book is great but you must have some common sense,which to me you sounds like you have little.just one other thing it would be in YOUR best interest that we dont meet. i no longer have anything to discuss with you. period0 -
There are people, one anyway, for whom I would NEVER perform CPR, no matter what. Uh, sorry, but my certification expired. [}:)] 0 -
quote:Originally posted by breddyrrt
Question for EMS. I worked for a medical company several years ago. We sold a product called Revive-it(sp). It was a backboard with straps that would do chest compressions. It was bought by Zoll. I have lost touch with the company. I was wondering if it ever caught on?
zoll produces it now, calling it the autopluse. very expensive, but very effective. limited field use due to cost($15,000/ea) coupled with the overall lousy odds for victims of cardiac arrest reagrdless of what gear is used.
quote:Originally posted by jwb267
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i am not as ignorant as what you may think.
i disagree. ignorant doesnt mean stupid, just uninformed about a particular topic.
the smartest doctors in the world have made mistakes.
i do believe that why we call it practicing medicine, but i hardly see what the has to do with the price of tea in china
it would be in YOUR best interest that we dont meet.
and this is where the wheels fell off your whole rant. resorting to thinly veiled threats.
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well anyway, i hope your class went well. although i doubt anybody could really teach you anything since you onviously know everything.0 -
Breddyrrt.....What you are describing is the Auto-Pulse. I mentioned it in my previous post. They are great tools. Like kevd said, they are expensive, though. He's right on with his price estimate of $15K. Our service has five of them now. 0 -
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you guys have 5 auto pulses? damn. you get a federal grant or just a really rich town? how have you found them to work with. are you all zoll or mix an match? just curious0 -
No, they weren't bought with grant money. We are hospital based and our hospital takes pretty good care of us. The Zoll Auto-Pulse is extremely easy to work with. I've had no complaints with the one on my truck. As far as our heart monitors, we have Physio LifePak 12's and we just got 16 of the latest Zoll monitors. Once we have all been trained on the ZOLL, we will have the option to carry either the Zoll or the Physio. Personally, I'll stick with the Physio. They're simple to use and have a lot of great features. Our service is real big into CO2 monitoring with the intubated patient and the Physio is great with that. Just in the past month, we updated the LifePak 12's so that we can use the Bluetooth feature on the monitor and send EKG's (12 Leads) directly to the Emergency Room from the field. This has really advanced our STEMI (S-T elevation MI) program. The STEMI program that we have is quite detailed. If you want more info, I'll post it. Not sure if everyone reading this thread is interested to hear it.[:D] 0 -
im quite interested but i doubt most are. maybe off line? 0 -
Actually, I'll post it in here. Some may not want to read it, but then again, there are lots of posts that I just skip over if I don't want to read them.[;)]
I'll try to describe the STEMI program as best I can:
S-T ELEVATION MYOCARDIAL INFACRTION
First, when our dispatch takes a call for chest pain, there are certain criteria that have to be met in order to start the STEMI protocol. The caller has to answer "yes" to certain questions, such as previous cardiac history, difficulty breathing, diaphoretic, etc. The dispatcher instructs the patient to chew 4 baby apsirin, provided they are not allergic. One of our units is dispatched and at the same time, a helicopter is dispatched to a pre-determined landing area. At this time, our CATH LAB is notified of a possible STEMI. Keep in mind, the service I work for covers two RURAL counties and sometimes we have a response time of 25 minutes and if the patient is on the far side of the county, we would be looking at a 50-60 minute transport to the ER. Once we arrive on the scene, one of our first priorities is to run a 12 Lead EKG. If the 12 Lead confirms a STEMI, we immediately transmit the EKG to the Emergency Room. We load the patient, start an IV, give O2, Nitro sprays, and Morphine en route to the helicopter. When we arrive at the helicopter, the patient is then flown directly to the hospital and goes directly to the CATH LAB. Most of the time, they do not even stop in the ER. There are times when the helicopter is not available, so we transport by ground. Either way, this has already been proven (by our service) to reduce the time that the patient is actually having the heart attack.
I'm sure I've left something out in this process and if I remember it, I'll post it here.0 -
Hey kevd...I forgot to mention this when I mentioned the Auto-Pulse, but we also just got new Stryker Power stretchers. Now THEY will spoil a person!!! Once the patient is on the stretcher, there's no more lifting!!!!!!! 0 -
quote:Originally posted by jwb267
quote:Originally posted by jeffery.boyd
You don't skip it all together, but emphysis is now on compressions. new adult CPR is 30 compressions to 2 ventilations. has to do with intrathoracic pressure and keeping the blood moving as frequent ventilations impede this.
you sir are the reason i have no love for medics in my area. i ask a simple question and i get a 10 minute speach about what you are obligated to do and a list of other medical terms that mean nothing to me or my family when i or them have to go to the hospital. i am sure there may be a place for medics but not in my area. i am tired of them trying to play GOD and insist that they must do this or that. you must remember that you can not force help to the people. and i sir would rather have an EMT that will check the ABCs and load and GO
jwb - just curious, but since you are an EMT who is/was headed to take a refresher class, why do you paint all other EMT/Paramedics with the hopeless-to-help brush (as in just load and go)? If these guys that do it everyday can't be trusted to administer CPR/drugs, etc, then why would anyone else even bother to take first aid/cpr? - in your opinion of course.
Is your experience with other EMT/Paramedics just limited to your area? I am not an EMT/Paramedic, but take classes many more times than once every two years, and in this process i see that over 600 persons are trained in first aid/cpr/AED use. I do not expect them to be remotely qualified to be an EMT/Paramedic. If what they do is stopped when the ambulance arrives and then the victum is "loaded and go" to a hospital that is at least many minutes/miles away - is their effort not useless? I guess what i am really hoping is that you see the real answer in my question....0 -
quote:Originally posted by dano
In the near future, "rescue breaths" will be gone. Chest compressions only.
your probably correct here. its being found that the hands off time necessary to ventilate in counterproductive
New standards will be 30 compressions per minute.
uuummm... no. 1 compression every two seconds? you mistyped. the current ratio in 30 compressions to 2 ventilations, with the compressions being given at a rate of at least 100/min
and for the sake of simplicity, we'll skip the differences in 1 v. 2 rescurer child cpr.
And yes.....CPR is way over-hyped. Very low success rate.
again, cpr ONLY is over rated. cpr was never meant to be a standalone life saver. its a maintence procedure until advanced life support can get there
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your just getting plain lazy! auto pulses and power strykers? hell, does your bus have autopilto to?
it sounds like you work in a great system. from the way you built it up, i thought you were going to hit me with prehospital thrombolytics. but your still a head of what we're doing.0 -
KEVD...No, we're not doing thrombolytics in the field. I did forget to mention one other thing...When we're working an arrest, we're using the AutoPulse and we have the option to put the patient on our ParaPac ventilators as well. So if I'm working an arrest and have the AutoPulse and the vent on the patient, all I have to do is administer drugs every three to five. Of course, I will evaluate the patient and confirm tube placement VERY frequently also. I think our service is really trying to spoil us!!!![:D] 0
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