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113Re: Updated guidelines

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  • Streonwold Wulfesbana (mka Steve Benetti)
    Dec 8, 2006
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      --- In E-Chir@yahoogroups.com, "Bethoc \(Lesley\)" > wrote: A lot of
      good stuff about resuscitation, below my own comments

      Bethoc, I think you just made my point.

      You see, MariaKatharina had said, "With the new modalities, we no
      longer teach the "lay person" to take a "pulse", anywhere, period...
      We are to only teaching/recerting EMS to "take pulses "..."

      And then Seonag asked, "Who is "we" ... " and, separately, "So, what
      about the first aid side (St. Johns and Red Cross) do they not teach
      that any more either?"

      And then MariaKatharina responded, "That was the whole point...
      The "we" IS everyone...
      It is not the "new Heart and Stroke guidelines".
      It is the new guidelines for cardiopulmonary resuscitation (CPR) and
      first aid were released recently by ILCOR, the International Liaison
      Committee on Resuscitation, in 2006, who are the body that reviews
      CPR and first aid every five years. "

      I was, in my clumsy fashion, trying to point out that not all
      first-aid involves resuscitation. There are many instances when a
      first aider will want to take a pulse, no matter what the protocol for
      resuscitation is.

      When I send a living patient to the hospital, they will have a note
      containing a full assessment of vital signs, a description of the
      mechanism of injury, suspected injuries, treatment rendered, and the
      patient's response to that treatment, as I've been taught.

      When resuscitation is required, the latest modalities that I have been
      taught are what I will use. Period.

      As for the "dumbing down" attitude - if you remove a level of
      assesment and decision from any process, it has been "dumbed down."
      Whatever the rationale. (I won't argue with the rationale - it's not
      my place to set standards for resuscitation.)


      > 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
      > *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
      > 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
      > solis sacerdotibus. Ave atque vale.
      > ---------------------------------
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