New ACLS guidelines: the unconscious with FBAO?!

[fiznat]

I took the ACLS class today (first day out of 2, we test tomorrow), and I wanted to ask you guys what you thought about the new ACLS guidelines for foreign body airway obstruction (FBAO). The guidelines say that for the unconscious patient, the ACLS provider should check for breathing as usual, and of course when no breathing is found, administer 2 slow breaths via BVM or whatever. In this scenario with the FBAO, the breaths do NOT go in. The next step in ACLS is not what what you think. You dont clear the airway. No ABD thrusts, nothing. The next thing to do, apparantly, is deliver CPR.

I was blown away. We dont clear the airway before going on to CPR?! I've never even heard of a protocol like this before. Thats the whole point of the sequence of A, B, C. That C doesnt matter if there is no A or B. The instructor pointed out that the alternative for ABD thrusts in the pregnant woman is chest thrusts, but even if this is supposed to be a substitute, ACLS offers no window to check the airway for dislodged obstructions. We're supposed go pump merrirly on with 30 compression cycles. What kind of CPR is that, to circulate blood with no oxygen supply!?

I complained about it, as did the rest of the class, but apparantly this is really the way ACLS wants it. The instructor shrugged and said that the AHA wants to make things as "easy as possible" for the lay person. I thought ALCS was supposed to be advanced, and not only that - how advanced is clearing the airway, anyways?

I dont understand this, guys. Can anyone find any reason in it?

[Ridryder 911]

The change is not to attempt to ventilate, remember that CPR is to be better even without attempting ventilatory support. This of course is for the laymen course, which assumes many does not understand the sequence.

Check out all the changes and explanations here... http://www.americanheart.org/downloadable/...2Winter2005.pdf

R/r 911

[Asysin2leads]

This reflects the new philosophy of CPR, that good circulation of poorly oxygenated blood is preferable to the poor circulation of oxygenated blood. I'm just curious, do they ask to check for a pulse? I guess not if its lay person CPR.

[AZCEP]

The assumption is that when you OPEN the airway it is clear to the point that you are able to visualize. Attempting ventilations proves that the airway is occluded, but does not tell you where.

Chest compressions are a more effective way to generate the artificial cough than abdominal thrusts. With the focus on circulation, we should consider that moving to earlier compressions may be a better route to take.

The management of FBAO is not typically addressed in ACLS, unless there is a BLS course being done at the same time.

[JPINFV]

Why: The goal of these revisions is simplification. Experts could find no evidence that a complicated series of maneuvers is any more effective than simple CPR. Some studies showed that chest compressions performed during CPR increased intrathoracic ressure as high higher than abdominal thrusts. Blind finger sweeps may result in injury to the victim’s mouth and throat or to the rescuer’s finger with no evidence of effectiveness.

Looks like your instructor needs to understand the changes before he teaches the changes.

[fiznat]

No, thats pretty much what I said the instructor told me. ...That chest compressions were being used not only as CPR, but as an alternative to ABD thrusts as it is done in pregnant women.

If we are using chest compressions instead, then, how come ACLS never offers a point to check the airway for dislodged obstructions?

I understand that CPR is important, even more important than ventilation for the first few minutes... but with a totally occluded airway (to the point that breaths dont go in), CPR alone with no attention to the airway is going to kill this patient! I just dont get it.

It seems ACLS is kindof in an odd spot in medicine here. It's advanced cardiac life support, and yet we're "learning" techniques for the lay person with more focus on simplicity than anything else.

Also to answer the question above, there is also NO check for pulse. If the patient is unconscious and not breathing, and the breaths dont go in, we're supposed to go right to CPR. :roll:

[JPINFV]

I understand that CPR is important, even more important than ventilation for the first few minutes... but with a totally occluded airway (to the point that breaths dont go in), CPR alone with no attention to the airway is going to kill this patient! I just dont get it.

Umm, except that according to AHA, chest compressions have been shown to have equal or greater increases in interthroatic pressure then abd thrusts. It looks like it's simplifying in the sense of "We can do 123410294 different procedures, or we can get the same results plus some more with 1 procedure. Let's go with the 1 procedure." The big picture is now saying that the same action that pumps the heart also pumps the lungs. It's the new 2 for the price of 1 deal.

For the pulse check, lay rescuers are now being taught not to check for a pulse. Nothing has changed for the health care provider course. It is being emphasized, though, that this should take as short of time as possible (<10 seconds)

[Dustdevil]

I understand that CPR is important, even more important than ventilation for the first few minutes... but with a totally occluded airway (to the point that breaths dont go in), CPR alone with no attention to the airway is going to kill this patient!

:head explodes:

[fiznat]

:head explodes:

?

[canuckEMT]

We just had our first class in FBAO yesterday. The algorhythm so far is this:

Find Pt unconcious

Check verbal no, pain no response

visualize in mouth, nothing seen

head tilt chin lift with ventilations via BVM, no air entry

reposition and try again, still no air entry

begin chest compressions

Prepare laryngoscope, magill forcepts and Ett

stop compressions

visualize airway and remove object with magill, if not seen, insert ett and attempt to ventilate again

So you are adressing the airway while attempting to dislodge the obstruction with the chest compressions.

I may have missed something being we have only covered this one day so far. If I have please feel free to add in where my information is lacking.