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akroeze

Elevating the feet during CPR?

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The reason you feel better is because you are increasing your ICP slightly. Remember syncope usually caused by the dilatation of vasculature lumen, (vasovagal syncope). Most current studies show positioning has very little effect, in this case. Peripheral vascular resistance is related to the vagal sympathetic response.. so actually, laying the patient in a supine position has the same effect. Allowing the body to auto-regulate itself and regain its tone is the main goal. Usually this is transient. That is why when people have simple syncope (fainting) episode, the usual treatment is no treatment other than placing them in a coma position to prevent airway obstruction. Mother nature will usually take care of itself.

I would never to suggest trendlenburg position for anyone with a headache, raising the ICP increases pain.

Remember all etiology of hypotensive episode is either related to volume, vessel, or pump problems. Either low on fluids (volume), dilation from either nor epi or medications or loss of neuro (vessel) or poor perfusion problems ( AMI poor cardiac output) all providing circulation to the brain. If you have poor cardiac output (<Pl/Al) , you will not have good cerebral blood flow.

R/R 911

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Remember all etiology of hypotensive episode is either related to volume, vessel, or pump problems. Either low on fluids (volume), dilation from either nor epi or medications or loss of neuro (vessel) or poor perfusion problems ( AMI poor cardiac output) all providing circulation to the brain. If you have poor cardiac output (<Pl/Al) , you will not have good cerebral blood flow.

That is where I was going with this. Cardiac arrest is not analogous to psychogenic or vasovagal hypotension. They are very different situations. Yes, Trendelenberg is, in my experience, beneficial to the faint patient. And it stands to reason, given the physiology. However, it is also just as likely that the victim feeling better has nothing to do with the position, and he was simply coming out of it on his own, regardless of position. I have seen no study which establishes a proven cause/effect relationship.

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IMO, in order to give the victim the best possible chance, I wouldn't move them at all. Except for IV, Intubation, resuscitation and CPR, leave them be. All of my saves happened while the patient had never been moved, including my first, back in 1952. I never moved them, I just performed my duty, and they came back. The ones who were moved by someone, or boarded and threw on the bed, never made it out of the hospital.

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That is where I was going with this. Cardiac arrest is not analogous to psychogenic or vasovagal hypotension. They are very different situations.
Right, I think that point needed to be made, rather than dismissing Trendelenberg (implying for all purposes)

Yes, Trendelenberg is, in my experience, beneficial to the faint patient. And it stands to reason, given the physiology. However, it is also just as likely that the victim feeling better has nothing to do with the position, and he was simply coming out of it on his own, regardless of position. I have seen no study which establishes a proven cause/effect relationship.
Though it's anecdotal, I've put myself into it and have felt immediate relief...and onset of "faintiness" was slowlly increasing, but recovery was pretty much instant. I don't think it was timing.

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It works good for keeping the patient from sliding off the end of the cot too. :wink:

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Ridrider and the rest of you- Thank you for posting this information. I never looked into the pathophysiology of the trendellenberg position, but I have had an on-going disagreement with a co-worker about this very subject. My co-worker is an intermediate that truly believes in the motto BLS before ALS, and will many times stop doing advanced treatments because he feels the BLS is sufficient. The one I have disagreed with the most is his assertion that trendellenburg is just as effective for the ride to the hospital as fluid replacement. Now I know why it didn't seem right to me.

I suppose that I have been too lazy to look it up for myself, but what incentive do I have to look things up? You guys answer all my questions without the research!!! Thanks!!! :oops:

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Rid,

I was wondering if you could provide the sources for the studies that you quoted. The use of the Trendellenberg position is one of discussion here at work currently. I read you posts with great interest and just wanted to read the studies for myself. 'Ppreciate it.

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What rid said is correct- but to answer the original question with terminology and reasoning even us dumb old B's can understand, the heart is next to the lungs and the brain is closer to the heart and has much less resistance to the blood being pushed out of the heart. So these three very important organs will get theirs easier than the toes will get theirs. The best thing to do is practice proper depth and technique for compressions during CPR.

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When a person is alive the body compensates by vasoconstriction along with the other obvious responses. So when in a hyplovolemic state the body is already shunting blood from the peripheries due to constriction. Have you ever seen a warm and pink cardiac arrest. When you elevate the lw extreme's it probably helps because there is vascular wall rigidity. This may help because of the bodies ability to maintain somewhat of an overall venous pressure. But when a person is dead there is no parasympathetic or sympathetic response and no systemic pressure at all. Its like taking a rubber water bottle adding a cup of water and lying it flat on a table and pushing down on it. It just sloshes back and forth and even if you apply a large amount of force the rubber wall will just stretch outward. Large fluid bolus is also not proving to be effective. So no matter what you do it will not help. When you have total vascular collapse its over. Think of D.I.C.

This is my overall opinion.

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What about Starling law? Does this not apply to cpr? Wouldn't elevating the legs add more volume to the ventricle, thus increasing the effectiveness and force of the compression?

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