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Discussion in 'Pre-Medical - MD' started by armybound, Feb 27, 2007.
Success does not matter
Yes, when a patient's family member fell out in the elevator I was in. I had to start until they called the code and the ER doc got there!!! Got her back though....of course not by myself....but...
Gosh, I remeber the first time I broke ribs during compressions too. It was a frail guy... nasty pops. I also remember the first time I did compressions. Guy came into the ED, full arrest. It was at the beginning of my first ever shift working as an ED tech. He survived. Apparently he coded a couple weeks later. I'm not sure if he made it that time, though.
I remember a time when I thought the worst sound in the world was resp. suction. AND THEN....I heard ribs crack during CPR. It just makes your skin crawl!!
A number of times for me, as well.
The first time you get a patient back, it's amazing. I've had the fortune of having that happen 3 times.
The number of times that you haven't gotten a patient back sticks with you, too.
yes, on a dummy in cpr class
You stole my answer.
*stolen answer five*
3-4 times for me, haven't broken ribs yet though.
More times than I can even count, but I can count the number of no disability, fully recovered pts on one finger.
spinoff: how many times does CPR actually save lives in this country? We should be getting defib training and using the Red Cross training money to buy more defibs for corridors and bathrooms and bingo halls.
Yep, I've delivered CPR through my volunteer work as an EMT-B. Try giving CPR continuously for 20 minutes on the way to the hospital ... my arms and shoulders burned so much, but at least the paramedic said it was "beautiful CPR" based on the rhythm I was able to set ... poor guy was already gone though ...
I've been a paramedic for 10 years....I'm in the category of doing CPR countless times. I also happen to do prehospital cardiac arrest research, and CPR actually does save lives in this country. Early defibrillation also saves lives, but patients in a shockable rhythm will maintain that rhythm longer when bystander CPR is performed. Those in a non-shockable rhythm may convert to a shockable rhythm when CPR is performed. Sudden cardiac death (SCD) is the leading killer in the US, as a subset of heart disease, and the vast majority of these events occur outside of the hospital. It may be true that the handful you'll see inside the hospital will be more successfully resuscitated with defibrillation. However, as the AHA reflects in their new guidelines, high-quality CPR is more crucial to patient outcomes that defibrillation....regardless of where the patient presents.
Fight the long defeat!
my cpr training included AED training. those things in all the hallways are fairly idiot proof to use. it detects shockable rhythms, tells you to stand clear, and shocks them at the appropriate intervals. all you have to do is properly place the paddles, which is explicitly illustrated.
I think your comments are a bit misleading, though obvioused well-intentioned. I teach CPR/AED for the AHA so I've been over it a million times with lay rescuers and EMT types. Obviously my expertise doesn't reach medics nor cardiac arrest research. The new AHA guidelines actually require one shock on the AED followed by CPR, because they found that 90% or so of people brought back are brought back with the first shock. The new emphasis on quality CPR is not to replace a defibrillator, as CPR will never bring a patient back on it's own. And the "quality" CPR we speak of is actually just CPR that is easier to remember and easier to perform and thus more likely to be effective. The absolute best CPR is not effective or remembered unless practiced often.
CPR training will always be essential. But as we transition to a point where AEDs are everywhere, the training is shifting so that AED and CPR become synonymous for resuscitation.
I think the differences in opinions about what is more important, defib or cpr, comes from a differences in perspective on the area of focus. For lay people with cpr/aed training, the recommendation of getting the first shock on the aed quickly stems from the response time of the bystander. The lay person walking down the street will most likely witness the cardiac event and have the aed applied and ready in less than ~2 mintutes, usually quicker. This means the pt will probably still be in a shockable rhythm that will convert because of decreased time of no perfusion. Pre-hospital providers are now recommended to provide "high quality" cpr for 2 minutes prior to shocking. The average response time for pre-hospital providers is about 6-7 minutes, but this varies greatly based on demographics of the area. A pt that has been in v-fib or pulseless v-tach for 6-7 minutes has not been perfusing anything for 6-7 minutes. The studies indicate that increased perfusion in the heart will make the heart more tolerable to conversion. Simple analogy: A car engine that sits for a relative short time without being started will usually turnover on the first try. A car engine that has not been started for a long time usually requires a person to pump the gas pedal before the engine turns over. I know this is a relatively simple analogy, but it kind of simplifies the theory behind the recent changes when teaching lay people. Anyway, the importance of cpr and aed's go hand in hand and both are required for effective management of a cardiac arrest. And the "quality" cpr is not just easier to remember, the studies have shown it to be more effecient in perfusing the tissue based on the quality and number compressions actually delivered and also lowered times of pauses in compressions.
I don't even know where to start after reading some of these posts. How about everyone here, even those that think they know everything because they teach CPR, sign up for this free journal:
You will soon find many of the CPR stories people tell could never happen. Some skills taught don't have studies backing them. Some skills taught are not the most effective treatment but are taught because it's easier for people to remember. There are scientific reasons, for the first time in AHA history actually, for the recent CPR changes and they aren't what people keep saying.
Same here. I've gotten pulses back a lot of times, but then again, if you dumped enough enough epi into a meatloaf, it would probably get a pulse, too. But I've only had one patient who I got a pulse back on that made a full recovery.
Three times: two wins, one loss. I ended up doing compressions on her for forty minutes and bagged her for another five before the attending called it.
Sorry, our job is just to get them to the hospital in the best possible condition we can. If they didn't die while they were with us, we probably did a decent job.
That's not what he's saying. I've been on both side of this; in the field you have no idea what will happen to a patient when you drop them off. In the hospital, I've seen patients go from OK to dead in a day. People in the field are notorious for telling stories, with the worst being instructors.
I see what you're saying, I just don't get why it's relevant. Our "success" isn't based on what happens hours after they're out of our care.
No, but I was a lifeguard for 4 years and came close. I did have to heimlich some aspirated water a few times/breathing, immobilized a spine (they ended up not being paralyzed, and someone had an epilleptic seizure.
Not as often as most people think. The NEJM found that on medical TV shows, CPR was successful about 75% of the time. In reality:
2% to 30% effectiveness when administered outside of the hospital
6% to 15% for hospitalized patients
Less than 5% for elderly victims with multiple medical problems
greytmedic has it right. A true save in the field is pretty rare. EMS-folks often have a habit of viewing a save as anyone that has a pulse when they get to hospital care, but those folks also rarely survive.
I think that CPR is often not contextualized well when it's taught. You do not do CPR to a person, you do CPR to a corpse. You can't "lose" the patient, the patient was dead when you started. Etc.
Agreed. This was a big mental hurdle for me to get over. Instead of feeling like I was inadequate, I had to realize that they were going to die if I wasn't there, so at least I gave it a shot.
No one I've ever performed CPR on has lived
No...we have an idea. Trust me, the medics who pat themselves on the back after getting pulses on a 90-year-old con home patient that they found in asystole are tools. The rest of us just laugh at them.
Yeah, but none of them are worse off than you found 'em.
Actually it's not a slap at the quality of the care delivered, but a statement that perhaps we should not be so quick to congratulate ourselves for "saving a life" prematurely when the pathophysiology underlying the arrest is unlikely to yield a positive outcome even with the best of care. However, to walk out of the resuscitation bay slapping each other on the back going "We saved them!" certainly does not help improve the image of EMS personnel among more educated persons who look at us, roll their eyes and chuckle at our apparent ignorance.
We're cocky. We're arrogant. We're full of ourselves. It helps us get through the monotony and the scut. And I think has to do with the lights and sirens, it's like the closest we ever got to our childhood dream of being a firefighter riding around with the dalmatian.
Man I dunno, I never felt that way. Of course all of my patients died, so.. haha.
I still see it more as a "They didn't die when they were with me" rather than "I saved a life"
Well, I'm in a similar boat to Nick and Greyt (although they are both medics and I'm an EMT-I), and I've seen very few saves over the past 10 years. I think I could count them (including in-hospital saves at my other job) on one hand, so you're not alone in not having (m)any saves....
Even the attitude you express regarding "they didn't die", still doesn't admit the truth. We are simply flogging a corpse for no benefit to the patient in >95% of codes. The true benefit of CPR in the majority of cases(in my opinion) lies in perhaps a role as a source of family being able to say "Everything was done".
I am going to try that tonight at dinner. One meatloaf with a side of epi please. Maybe it will make it taste better.
High dose or standard dose?
On humans and rats. Succesfully.
Rats eh? I've done CPR on a dog before.....and made an EMT student work on a squirrel that was electrocuted on a power line next to our station
I have done a few in the past.
Oh yeah, almost daily. You get a little syringe that fits over their nose and go to town.
Interesting......I never thought of that.....I know one of the ambulance services and at least two fire departments around here carry O2 masks for animals that are pulled out of fires.
I have once, to no avail... good experience
A few times pre-hospital, and I've lost count of the times I've done cpr while working here at the hospital. I've only boken ribs a couple of times, but the first time I did was on some 84 year old lady who was demented, but the family insisted be a full code (another thread entirely). Not only did I bust ribs, but I'm pretty sure I managed to separate her manubrium from the body of the sternum, too. She didn't make it for several reasons, but I gave good CPR.
I've always felt that we do CPR for the 10 in 100 that survive the code, and the 1 out of those 10 that go home and live a normal life. Might as well give them every chance. (those numbers are obviously contrived, but you get the point)
i think most dying patients would beg to differ...
Yes, I have a few times. I don't count them and I can't believe you all do.
Seems depressing to keep score. It is not baseball; There are no wins or losses.
So you do your best. Maybe only keeping the blood moving for 30 minutes while a very QUICK differential is drawn together, and a discussion on the possibility of actually bringing the person back.
Usually, it is useless. But you can't NOT try. Sure, its pathetic, and I have definately pumped chests of 80yos who didn't stand a chance. The thing is, I'll bet the hopeless 80yo's family didn't think he didn't stand a chance. So you do it for them as much as anything. After all, we are the ones who have to break the news...
I am a CPR instructor for the red cross, does that count, although I never have done it on a real person.
Almost every other night.
Done it twice at work but with other nurses. I have never gotten to do compressions only breaths.
For me, just on rats.
But not the mouth-to-mouth part.