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112Re: [E-Chir] Re: Updated guidelines

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  • Bethoc (Lesley)
    Dec 8, 2006
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      Greetings all!
       
      The CPR guidelines get reviewed (and modified) every 5 years. This year is a "grandfathering" year as many people will have been certified by old standards because their instructors were not given the new information until late in 2005. There is always a delay in roll-out.
       
      *snip*

      "Streonwold Wulfesbana (mka Steve Benetti)" <streonwold@...> wrote:
      What "the world" is teaching "lay" responders doesn't affect me at the
      hill. At the hill I'm the first link in the chain of 911 response.

      Away from the hill, as a Chirurgeon, I guess I should respond as a
      "lay" responder, but I am no more capable of dumbing down my
      responsiveness than would be an MD, a nurse or an EMT. My treatments,
      .

       
       
      *return to diatribe*
       
      The changes in the CPR guidelines are not just "dumbing down" of information, and it's not just being taught to lay-people. Keep in mind that this isn't being done to "take away" knowledge from the trained provider. A responder can take pulses to their heart's delight on every other patient (wherever she/he likes to stick look for a pulse *smirk*). And it is certainly an important skill to have.
       
      The changes are based on scientific study that is been researched and reviewed by major world-wide organisations. In the end of it all, the changes are to better the outcome for the individual (not to enhance the experience for the responder!). Of course, in five years time, they will re-evaluate and see if these changes are helpful (don't you like being guinea pigs?)
       
      The rationale is all about getting blood oxygenated and circulated *quickly*.
       
      Consider :
      In cardiac arrest, the heart is quivering and/or not moving and therefore not able to pump out blood. Regardless if the collapse is witnessed or not, if the airway is open and there is no breathing it is logical to assume that an immense cardiac event could be a causative factor. It takes a least 20-30 seconds to get to the "pulse check point" from the discovery of the casualty, checking and securing the scene, calling for help, assessing responsiveness, sending for help, look, listen, feel, and ventilate x 2. So why wait to check a pulse? Even with the fastest 10 second carotid pulse check, this now approaches 30-45 seconds less that the casualty/patient's heart is getting oxygenated blood from the beginning of the event (not considering the the seconds to minutes that the person's heart malfunctioned enough to cause the collapse!). We were taught to be scared of doing damage to the heart during CPR if it was beating. I think that's why we sill want to do the pulse check. Well it looks like the damage it may cause is overshadowed by the benefit of circulating oxygenated blood. Besides, if breating has stopped because of cardiac arrest, what little heartbeat there is will soon stop.
       
      Consider:
      The ratio of compressions to ventilations has changed to facilitate teaching and retention, yes. However, the ratio also provides for improved circulation of oxygenated blood. What's the point of oxygenating blood if it doesn't get circulated properly? We now perform 100 compressions/minute of hard and fast CPR with full compression recoil (i.e. come all the way up after you compress to let the heart fill). Since it takes 4 minutes for brain damage, you're not doing any harm to the person to circulate oxygenated blood for 1 minute between breaths (ie 30:2 compression:ventilation ratio) especially to the coronary (heart) muscles which need it the most at that moment. Even in ACLS and ER treatment, which includes drugs and electric shock delivery, we now employ two minutes of CPR to let the drugs circulate between electric shocks. This is a big change for acute care providers!
       
      Consider:
      You attend to someone whose family member happens to know the latest CPR guidelines... and understands there is rationale behind them (even if that person doesn't know what or why, a lawyer can find out for them!)... who can then bring into question the scientific logic behind a responder being "old school". I'd be concerned about legal issues then! It's hard to throw off your teaching, I know... believe me in ACLS the idea of not shocking a person three times in a row to start with (which we used to do) is a mental jump for many of my colleagues and I. But I'd suggest that a responder would have to be careful to perform as she/he were certified to with the new guidelines in order to protect her/hiself... besides, this information is also released as "best practise" and it is the best we have to go on right now.
      Personally, I perform my acute emergency response with the latest guidelines (even if I can do CPR compressions for longer than the recommended two minutes, I don't want someone to accuse me of peforming poorly and causing harm... so the switch off, when we can do it, is two minutes. simple)
       
      and if five years time...who knows how things will change then???
       
      stay warm!
      Beth{o'}c
       


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