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RE: [E-Chir] Re: Updated guidelines

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  • S. Rabinovitch
    ... [S. Rabinovitch] And Streonwold replied: That s exactly what you re supposed to do. ... I do what I m trained to do - identify life threats, try and
    Message 1 of 9 , Dec 7, 2006
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      --- In E-Chir@yahoogroups. com, "Jeff MaGee" <commie_smurf@ ...> wrote:

      > With all this updating going on and whatnot, unless it would breach
      > any insurance coverage I'll continue to treat individuals as I've
      > been trained to.

      [S. Rabinovitch] And Streonwold replied: 
      That's exactly what you're supposed to do. 

       ... I do what I'm trained to do - identify life threats, try and prevent
      death, attempt resuscitation if indicated (using the new CPR
      protocol), call 911 when necessary (essentially what I do on the hill).

      I don't see any problems.
      [S. Rabinovitch] NEITHER DO I.

      <Signed, your Kingdom boss-lady>  <GRIN>

      .

    • Bethoc (Lesley)
      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
      Message 2 of 9 , 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
         


        solis sacerdotibus. Ave atque vale.


        Share your photos with the people who matter at Yahoo! Canada Photos

      • Streonwold Wulfesbana (mka Steve Benetti)
        ... 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,
        Message 3 of 9 , 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.)

          warmly,
          Streonwold

          > 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
          > *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
          >
          >
          >
          > solis sacerdotibus. Ave atque vale.
          >
          > ---------------------------------
          > Share your photos with the people who matter at Yahoo! Canada Photos
          >
        • Bethoc (Lesley)
          this made me smile... Streonwold wrote: When I send a living patient to the hospital, they will have a note containing a full assessment of vital signs, a
          Message 4 of 9 , Dec 8, 2006
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            this made me smile...

            Streonwold wrote:
            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.

            .

             
            because quite often, I get "half" reports from medics arriving in the emergency (often they may have a "scoop and go" patient... but sometimes it's ... well... can't be bothered. I ask allergies? and they turn to the patient and say "do you have any allergies"). Whereas many first aiders I know are respectably trained to get a full history and give a *good* report!
            what would the world do without us?
             
            equally warmly,
            Beth{o'}c (the tongue twisted)


            solis sacerdotibus. Ave atque vale.


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