Arctickat Posted May 8, 2012 Share Posted May 8, 2012 So, one of my slaves is taking her first PALS class and she's worried that she flunked a scenario because she did 2 minutes of CPR on a peds patient in Vfib rather than defib ASAP. I tried to determine if this is considered a Critical Error, but I can't find any reference. Any PALS instructors out there know if this would be an automatic fail for her? Link to comment Share on other sites More sharing options...
chbare Posted May 9, 2012 Share Posted May 9, 2012 http://circ.ahajournals.org/content/122/16_suppl_2/S325.full I teach PALS. This would not be a "critical error" if I were running a megacode station. Link to comment Share on other sites More sharing options...
croaker260 Posted May 9, 2012 Share Posted May 9, 2012 (edited) There is a general guideline for two minutes of uninnturuped CPR for 2 minutes that is dependant on a couple fctors: 1- Its a recommendation for EMS providrs, not in hospital. Thereforee in-hospital PALS instructors may not be familier with it. 2- It is indicated for estimated down times in excess of the 1.5-4 minute mark. for down times LESS than that, the immediate defib is indicated. In adults with prolonged arrest and in animal models, defibrillation is more likely to be successful after a period of effective chest compressions. CPR Before Defibrillation In adults and children with cardiac arrest due to VF (out-of-hospital or in-hospital) does the use of CPR before defibrillation, as opposed to standard care (according to treatment algorithm), improve outcomes (eg, ROSC, survival)? Consensus on Science In 2 randomized controlled trials (LOE 1), a period of 1½ to 3 minutes of CPR by emergency medical services (EMS) personnel before defibrillation did not improve ROSC or survival to hospital discharge in patients with out-of-hospital VF or pulseless ventricular tachycardia (VT), regardless of EMS response interval. One before-and-after study (LOE 3)and another study (LOE 4)failed to demonstrate significant improvements in ROSC or survival to hospital discharge when a strategy of CPR before defibrillation (CPR first) was compared to a shock-first strategy. In the Hayakawa study, the CPR-first group showed a higher rate of favorable neurologic outcome 30 days and 1 year after cardiac arrest.3 One randomized controlled trial (LOE 1)and 1 clinical trial with historic controls (LOE 3) comparing CPR-first versus shock-first also found no overall difference in outcomes. However, in both studies, improvements in ROSC, survival to hospital discharge, neurologic outcome, and 1-year survival were observed in a subgroup of patients who received CPR first where the EMS response interval was >4 to 5 minutes. Treatment Recommendation There is inconsistent evidence to support or refute delay in defibrillation to provide a period of CPR (90 seconds to 3 minutes) for patients in non EMS witnessed VF/pulseless VT cardiac arrest. This is from the PALS section of the guidlines and is secifically pesented as a consideration in pedaitric arrest. Copy of all the circulation "science behind the changes" issue is available here: http://circ.ahajourn.../18_suppl_3.toc So my opinion as a PALS instructor, without being there to observe the performance, is that its not a critical fail at all. Edited May 9, 2012 by croaker260 Link to comment Share on other sites More sharing options...
DFIB Posted May 9, 2012 Share Posted May 9, 2012 So, does she know you think she is your slave? Link to comment Share on other sites More sharing options...
Arctickat Posted May 9, 2012 Author Share Posted May 9, 2012 (edited) Yup, I call all my slaves, slaves. She's a very good natured girl. She'll be happy to hear your consensus, I like my slaves to be happy. Thanks a bunch. Edited May 9, 2012 by Arctickat Link to comment Share on other sites More sharing options...
DFIB Posted May 9, 2012 Share Posted May 9, 2012 Glad she did well. Link to comment Share on other sites More sharing options...
Arctickat Posted May 10, 2012 Author Share Posted May 10, 2012 DFIB, how did you know she did well before she did? hmmm.... Got her results, 94% on the written and passed both scenarios. Over half her class has to redo the scenario portion. Thanks for the info guys, it helped alleviate her anxiety. Link to comment Share on other sites More sharing options...
DFIB Posted May 10, 2012 Share Posted May 10, 2012 Wow, turns out I am psychic. DFIB, how did you know she did well before she did? hmmm.... Got her results, 94% on the written and passed both scenarios. Over half her class has to redo the scenario portion. Thanks for the info guys, it helped alleviate her anxiety. Link to comment Share on other sites More sharing options...
1EMT-P Posted May 19, 2012 Share Posted May 19, 2012 I would not consider it a failure, it would be normal to start BLS first, then start ALS. Link to comment Share on other sites More sharing options...
Kiwiology Posted May 19, 2012 Share Posted May 19, 2012 Trev, mate, do you need another slave? Wait, is your other slave hot eh? Link to comment Share on other sites More sharing options...
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