QUESTION REGARDING PROTOCOLS

[EMSLuke134]

I have a protocol question that has been bothering me. This is from a BLS standpoint. We all know that speaking from protocols the priority of actions in a cardiac arrest are as follows.

Airway

Breathing

Circulation

Defibrillation

All that is ever drilled into us is the idea of "stop and fix". If there is a problem with A you fix it before going on to B etc.

Of course this is the ideal world of textbooks. We all know that in practicality the streets are far from ideal. Keeping what i have said so far in mind, help me with the following case.

A pt is in cardiac arrest, caused by asphyxia due to an airway obstruction by a forgien body. Technically, we cannot assess circulation and determine that the pt has arrested, because we still have not corrected Airway. Heck, on a BLS level we may not ever successfully treat the obstruction until ALS arrives or the pt arrives at definative care.

We also know that the chance of successful defibrillation (especially BLS/AED) dramatically decreases with each minute that passes. What is the proper way to handle this situation? do we continue with ABCDs once we realize Airway will take some time to fix? I know that the person needs a defib ASAP, but do we check for a pulse and start CPR and AED while working on airway simultanouesly? Is there any use, because after some time we will just be circulating de oxygenated blood. Any and All input would be greatly appriciated.

[Scaramedic]

Your initial ABC's are just a quick assessment, is their airway clear, are they breathing, do they have a pulse. At that point it is just checking the baseline of where your pt is. Now the question becomes what to fix first. If the pt. has stopped breathing due to a foreign body you must first remove the foreign body, abdominal thrusts, mcgills, etc. You've cleared the airway now, is the pt breathing on his own? No, give some BVM ventilation's and make sure you have chest rise. Then its time to deal with whether or not they have a pulse. If they do cool, if they do not its defib time.

Like I said your initial ABC's are just a quick assessment, you fix the problems after you have checked those three.

Hope that helps.

Peace,

Marty

:joker:

[Acosell]

You can defib till the cows come home, but unless that airway is clear, your patient is toast.

The blocked airway is the cause of the arrest, so you won't be able to fix it unless you fix the blocked airway.

Like scaramedic said, assess ABCs, and then when you have the whole picture treat. The unconscious foreign body airway obstruction procedure includes CPR now anyway.

[Ridryder 911]

Really, there is reason for this madness of learning. It is called treating the etiology. Finding the cause. Like other have pointed, it does no good to even check the4 pulse if the patient is not breathing, (again this may be the underlying cause) as well as priority. Getting back to basics, the brain (most essential organ) has to survive...

I also suggest, that you look at new literature and standards in regards of rapid defibrillation. As studies has now proven, that good CPR has a more likelihood of converting ventricular fibrillation , than initially just shocking someone. Things has changed.

R/r 911

[EMSLuke134]

Thank you everyone for youre input. i was thinking about the situation the wrong way. Even if you successfully defib somebody who is in arrest with an airway obstruction their still toast, because the obstruction is what caused the arrest, so that must be fixed before you can even worry about treating the arrest. simple concept, somehow i missed it when i pondered this situation. thanks for all the help guys.