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Re: [E-Chir] Re: Updated guidelines

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  • 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 1 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.


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    • 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 2 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 3 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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