Hold your ground during the charge!

-

Excuse me? you said what?
"In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses." (Cheskes et all., 2013)

Decreasing peri-shock pauses is a good thing. 

Fig. 2. Cheskes et all., 2013
The less time we are squeezing the chest, the less time the victim is perfusing and the less their chances of survival. To maximize perfusion, the 2010 AHA Guidelines for CPR and ECC recommend minimizing pauses in chest compressions. Expert consensus is that a Chest Compression Fraction (CCF) of 80% is achievable in a variety of settings. (Meaney et all., 2013) A viable method to decrease compression pauses is to perform compressions as shocks are charged and delivered*. The purpose of CPR is to compensate for the failure of the heart to adequately pump blood throughout the body. We're trying to perfuse the heart (and brain) well enough to get the heart excitable (Ventricular fibrillation/Tachycardia) and restartable (Shock/defibrillation). 

From RebelEM
*While some evidence suggest CPR during defibrillation is safe and has benefit (Neumann et all., 2012)  the AHA does NOT recommend it. Rescuer safety is the highest priority in any scenario and should stay that way!

However, as technology evolves and research continues we may find a way to safely keep hands on during the entire incident. With the increasing frequency of CPR quality monitoring devices (or CPR pucks as I've called them so far) we may have a viable barrier to protect providers from electrical shocks, with the risk of redirecting high voltage electricity into monitors worth thousands of dollars.

Until that day, remember an 80% CCF and rate of 100-120. feel free to use this excellent reference material for a rate.


Bibliography:

Cheskes, S., Schmicker, R. H., Verbeek, P. R., Salcido, D. D., Brown, S. P., Brooks, S., … Christenson, J. (2014). The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation, 85(3), 336–42. doi:10.1016/j.resuscitation.2013.10.014

Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R., Bhanji, F., … Leary, M. (2013). Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation, 128(4), 417–35. doi:10.1161/CIR.0b013e31829d8654

Neumann, T., Gruenewald, M., Lauenstein, C., Drews, T., Iden, T., & Meybohm, P. (2012). Hands-on defibrillation has the potential to improve the quality of cardiopulmonary resuscitation and is safe for rescuers-a preclinical study. Journal of the American Heart Association, 1(5), e001313. doi:10.1161/JAHA.112.001313

Comments

Post a Comment

Popular posts from this blog

NREMT AEMT

-
Image
Finally! I have in my hands my NREMT certification and my Maine EMS license! Thank you mail man! My pretty little certification Some swag! I don't know what I'm going to put it on. I might get a spring coat and put it on that. Last but not lease my NREMT card!  I'm also signed up for my Paramedic class in September which is good. It will be interesting to try and manage work, school, and life but i'm excited for the challenge. I would be interested to hear some poor medic student stories if People have them.
Read more

Reading 2014: Peter Pan.

-
Wow. What a fun book . At 200 pages it's a quick read. However! The book still covers a lot not seen in the Disney movie, shocker right? Well, I'm sure most everyone has seen the Disney movie of Peter Pan. So the plot of the book was used for the movie. What I enjoyed about the book so much more is the narrator acts like a living entity in the story! Suppose, to make her happy, we whisper to her in her sleep that the brats are coming back. They are really within two miles of the window now, and flying strong, but all we need whisper is that they are on the way. Let's. It is a pity we did it, for she has started up, calling their names; and there is no one in the room but Nana. ~ Peter Pan, Pg 188. It makes you feel like you're a ghost, quietly following the stories and adventures of Peter, Wendy, and the Lost boys. Only rarely whispering into their world, When you do though... Bone chilling. Even just reading that the narrator is doing it pulls you that much tight...
Read more

60 Hours a week.

-
Hello. My name is Nicholas. I work for a private Ambulance. Now that I am fully oriented I work 60 hrs a week. I couldn't be happier, or more tired. I'm making major bank. ------------------------------------------      Anyways.... So I'm working Delta for real now and It's both fun and tiring. I'm working nights on the BLS truck, I get to take care of your sweet hearted granny!..... And your crazy ass uncle that's a Vietnam vet... so it's a fair trade. After a week I was on Reddit EMS  and they had a good post about gear guys carry. pretty standard info. Good stethoscope, trauma shears, pen. well  I have all of those... but it's a lot to keep in your pockets and when you're trying to catch a quick nap  it sucks to have shears stabbing your quad. So I went and ordered a molle drop leg with some pouches. I'll see how it goes and post pics and such when I get everything in and running.      Now I know I should take some ...
Read more