ERDoc

I just read today that the OPALS (Ontario Prehospital Advanced Life Support) Study has shown that there is no difference in several survival endpoints for trauma pts that are treated by BLS vs ALS units. The only difference was that in pts who were intubated the outcomes were worse (although the article did not say if these pts were sicker). I'm not trying to start an ALS vs. BLS war, I was just curious as to everyone's thoughts on it.

Do you have different fluids that you can give? In my area the EMS guys only have NS. They used ot have D5W for medical pts and LR for trauma, but this changed to NS for everyone several years ago.

In my neck of the woods, the crews can only start lines (no locks). They can draw bloods, but I have never seen one do it, and I don't think the nurses will take it.

Although I haven't had the opportunity to try it, I have seen anesthesiologist intubate a pt in a near upright position. They say that the airway is much easier to visualize and is more of a straight line. I have actually seen them jump up on the back of a hospital stretcher and do it standing about 3-4 feet off the ground. I can only assume that the airway is more patent in the sitting position, even for bagging. I have had the opportunity to bag someone in the sitting position and didn't have any problems. You just have to make sure that you bag when they inhale.

I set up my jumpbag after I received my first responder certification (with the usual BLS stuff 4X4s, Kling, etc). I pulled it out of my trunk the other day to use it and realized that I haven't used it in a long time. I found saline and water that expired in 1993. The 4X4s crumbled when I tried to fold them. I was getting some stuff out for my son who tried to catch a baseball with his teeth. He just looked at me like I was crazy.

Just a few abstracts from a few studies that might help to enlighten the conversation a little (I know it is a little wordy, sorry about that):

Resuscitation. 2005 Jun;65(3):325-8. Epub 2005 Jan 24.

A comparison of CPR delivery with various compression-to-ventilation ratios during two-rescuer CPR.

Hostler D, Guimond G, Callaway C.

University of Pittsburgh, Department of Emergency Medicine and the Affiliated Emergency Medicine Residency, 230 McKee Place, Suite 500, Pittsburgh, PA 15213, USA.

BACKGROUND:: The number of chest compressions required for optimal generation of coronary perfusion pressure remains unknown although studies examining compression-to-ventilation ratios higher than 15:2 (C:V) in animals have reported higher C:V to be superior for return of spontaneous circulation and neurologic outcome. We examined human performance of two-rescuer CPR using various C:V. METHODS:: Thirty six EMT-Basic students in their final week of training performed two-rescuer CPR using C:V of 15:2, 30:2, 40:2, 50:2, and 60:2 on a recording resuscitation manikin. Compression and ventilation variables were recorded by computer while the number of pauses for ventilations and the hands-off time (time not spent performing chest compressions) were abstracted by hand. Data were analyzed by ANOVA and significant differences from the standard treatment of C:V=15:2 were assessed by Tukey's HSD post hoc test. FINDINGS:: The number of compressions delivered per minute increased with increasing C:V while the hands-off time and pauses for ventilations decreased. All comparisons were significantly different from C:V=15:2 (P<0.001). The ventilation numbers decreased with increasing C:V although mean minute volume exceeded 1l for all C:V. INTERPRETATION:: A 15:2 compression-to-ventilation ratio when performed during two-rescuer CPR results in 26s of hands off time each minute while only delivering 60 compressions. Alternative C:V ratios of 30:2, 40:2, 50:2, and 60:2 all exceed the AHA recommended 80compressions/min while still delivering a minute volume in excess of 1l.

Ann Emerg Med. 2002 Dec;40(6):553-62.

Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios.

Sanders AB, Kern KB, Berg RA, Hilwig RW, Heidenrich J, Ewy GA.

Sarver Heart Center, the Arizona Emergency Medicine Research Center, Department of Emergency Medicine, University of Arizona, Tucson, USA. art@aemrc.arizona.edu

STUDY OBJECTIVE: The optimal ratio of chest compressions to ventilations during cardiopulmonary resuscitation (CPR) is unknown. We determine 24-hour survival and neurologic outcome, comparing 4 different chest compression-ventilation CPR ratios in a porcine model of prolonged cardiac arrest and bystander CPR. METHODS: Forty swine were instrumented and subjected to 3 minutes of ventricular fibrillation followed by 12 minutes of CPR by using 1 of 4 models of chest compression-ventilation ratios as follows: (1) standard CPR with a ratio of 15:2; (2) CC-CPR, chest compressions only with no ventilations for 12 minutes; (3) 50:5-CPR, CPR with a ratio of 50:5 compressions to ventilations, as advocated by authorities in Great Britain; and (4) 100:2-CPR, 4 minutes of chest compressions only followed by CPR with a ratio of 100:2 compressions to ventilations. CPR was followed by standard advanced cardiac life support, 1 hour of critical care, and 24 hours of observation, followed by a neurologic evaluation. RESULTS: There were no statistically significant differences in 24-hour survival among the 4 groups (standard CPR, 7/10; CC-CPR, 7/10; 50:5-CPR, 8/10; 100:2-CPR, 9/10). There were significant differences in 24-hour neurologic function, as evaluated by using the swine cerebral performance category scale. The animals receiving 100:2-CPR had significantly better neurologic function at 24 hours than the standard CPR group with a 15:2 ratio (1.5 versus 2.5; P =.007). The 100:2-CPR group also had better neurologic function than the CC-CPR group, which received chest compressions with no ventilations (1.5 versus 2.3; P =.027). Coronary perfusion pressures, aortic pressures, and myocardial and kidney blood flows were not significantly different among the groups. Coronary perfusion pressure as an integrated area under the curve was significantly better in the CC-CPR group than in the standard CPR group (P =.04). Minute ventilation and PaO (2) were significantly lower in the CC-CPR group. CONCLUSION: In this experimental model of bystander CPR, the group receiving compressions only for 4 minutes followed by a compression-ventilation ratio of 100:2 achieved better neurologic outcome than the group receiving standard CPR and CC-CPR. Consideration of alternative chest compression-ventilation ratios might be appropriate.

I think I've taken up enough space for now. Hope this helps.