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Cardiac Arrests: Stopping To Check Pulses?


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#16 BEorP

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Posted 27 March 2009 - 04:55 PM

While pulses present might not indicate effective CPR, the lack of pulses during CPR may indicate ineffective CPR (or hypovolemia, etc).


But the lack of pulses could also mean nothing in terms of the quality of CPR... Why not just focus on adequate rate, depth, and recoil?
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#17 AnthonyM83

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Posted 27 March 2009 - 05:46 PM

But the lack of pulses could also mean nothing in terms of the quality of CPR... Why not just focus on adequate rate, depth, and recoil?

Why not focus on more than just that if you have the time? It's already assumed you're watching for good rate, depth, and recoil.
Pulse check might increase your index of suspicion on faulty CPR (combined with questionable rate, depth, recoil, fitness of provider, time doing CPR, etc) and of hypovolemic state (combined with skin signs, medical history, environment, ECG rhythm, etc etc).

I try to have my fingers on the neck before CPR is stopped to do the pulse check, so how does that slow the team down?
Especially, when you have everything else taken care of.


It's one thing to take action based on a random assessment that has no evidence base and another to note several common sense findings that could add up to a big picture combined with evidence based assessments.

Edited by AnthonyM83, 27 March 2009 - 05:47 PM.

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#18 BEorP

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Posted 27 March 2009 - 07:03 PM

Why not focus on more than just that if you have the time? It's already assumed you're watching for good rate, depth, and recoil.
Pulse check might increase your index of suspicion on faulty CPR (combined with questionable rate, depth, recoil, fitness of provider, time doing CPR, etc) and of hypovolemic state (combined with skin signs, medical history, environment, ECG rhythm, etc etc).

I try to have my fingers on the neck before CPR is stopped to do the pulse check, so how does that slow the team down?
Especially, when you have everything else taken care of.


It's one thing to take action based on a random assessment that has no evidence base and another to note several common sense findings that could add up to a big picture combined with evidence based assessments.


I appreciate your desire to do more assessments, but there is no sense in doing assessments that aren't truly assessing for anything meaningful. Someone could be doing perfect CPR and not generate any type of pulse and on another call there could be poor quality CPR that generates a venous pulse. By adding in this assessment we gain no information that can help us to better care for the patient.
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#19 AnthonyM83

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Posted 27 March 2009 - 08:04 PM

I appreciate your desire to do more assessments, but there is no sense in doing assessments that aren't truly assessing for anything meaningful. Someone could be doing perfect CPR and not generate any type of pulse and on another call there could be poor quality CPR that generates a venous pulse. By adding in this assessment we gain no information that can help us to better care for the patient.

Couldn't you liken that to an O2 sat?
You could have a good have someone well-oxygenated with a good O2 sat on one call, then on another call with good poor oxygenation but even better O2 sat? BUT combine a bunch of things and it might lead give you an index of suspicion.

No pulses, might make me review the person doing CPR again...
and I might say: "Nope, he's doing a good job. We're good there."
or: "Hmmm, that's not as good CPR as it good be, gotta remember to get others to switch out with him for a few rounds"
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#20 theotherphil

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Posted 27 March 2009 - 09:02 PM

DRABC? That's a new one on me.

Is this an Aussie thing, or am I just out of the loop?



DRABC is used in the UK as well as Aus. Danger Response Airway Breathing Circulation etc


Once cardiac arrest is confirmed with an initial pulse check, I wouldn't check again unless there's a rhythm change (and after finishing the 2 mins CPR). No pulse check straight after a shock due to myocardial stunning, although this is lessened on biphasic defibs.

edit: speeling

Edited by theotherphil, 27 March 2009 - 09:10 PM.

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