CPR and defibrillation

[Indryd]

Witnessed drop in a hospital parking lot and is pulseless. Defibrillator 2 minutes away.

Do you actually NOT start compressions until after shock?

Starting compressions while you wait for the defibrillator to arrive seems appropriate, but I just got it wrong on an exam.

Answer explanation said for a witness drop and pulseless and difibrillator less than *4 minutes* away ALWAYS shock before compressions.

Thoughts?

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[Lawsonc]

I would jump on the chest, whats happening to that coronary perfusion pressure as you stand there waiting?

EDIT- Could it be based on old science? an old question? I recently took a department test I got wrong when I opted to jump on the chest. The question started with a dispatch for man down, and then a patient you find in V-fib, according to the test the answer was defibrilate with a monophasic defibrillator at 360. I should have guessed it was an old question, with the mention of a monophasic defibrillator.

 

[Rendar5]

Test is based on old guidelines. 2010 guidelines support jumping on chest immediately.

 

[jbar]

I think the question doesn't understand the new guidelines, which basically say if you show up with a defib, and the patient has been down for more than 4 minutes, do compressions before shocking to improve the chances of sucessfully geting ROSC.

That is the point of the question. But the way the scenario is worded is really a different situation. You should be doing compressions in a pulseless patient while waiting for the defib to arrive.

 

[Indryd]

Cool guys. Old question makes sense.

So what do you all think I should pick if it comes up on Step II?

 

[Rendar5]

I don't think this is step II material.

 

[Texas007]

You should get on that chest and pump until you get the defib. This should not be step 2 material.

 

[Hawk22]

Test is based on old guidelines. 2010 guidelines support jumping on chest immediately.

Exactly right.

 

[Indryd]

I don't think this is step II material.

It was in my step 2 qbank from usmleworld. /

 

[Rendar5]

It was in my step 2 qbank from usmleworld. /

well, i'm still willing to bet it won't end up on an exam. If it does, look me up and i'll take you out for a steak dinner

 

[K31]

Answer explanation said for a witness drop and pulseless and difibrillator less than *4 minutes* away ALWAYS shock before compressions.

Thoughts?

I can't imagine this being the correct answer even before the 2010 CPR changes. Sure, the guidelines didn't emphasize compressions as much as they do now, but it makes no sense to just stand around and wait for up to 4 minutes for the defibrillator to get there. That's 4 minutes of no circulation and dying neurons.

 

[canjosh]

Witnessed drop in a hospital parking lot and is pulseless. Defibrillator 2 minutes away.

Do you actually NOT start compressions until after shock?

Starting compressions while you wait for the defibrillator to arrive seems appropriate, but I just got it wrong on an exam.

Answer explanation said for a witness drop and pulseless and difibrillator less than *4 minutes* away ALWAYS shock before compressions.

Thoughts?

Such a scenario is the only time I might do a precordial thump. Anybody ever do one? I have...it hurts your hand. But yeah, would get on the chest right away like everybody else has said.

 

[pinipig523]

Test Answer:
Shock first, cpr later.

But in reality - if the machine is 2 minutes away - cpr first. After all, two things lead to successful defib. One is time from drop, the less - the better. The other is good quality CPR.

So, if you have 2 minutes - I'd rather compress the guy rather than do nothing and wait to shock.

 

[Jack is Back]

Test is based on old guidelines. 2010 guidelines support jumping on chest immediately.

yup. I learned post 2010 and jumping on the chest was #1.