New ACLS guidelines: the unconscious with FBAO?!

[Stretchermonkey]

Over here in the UK, we use the European Resuscitation Council (ERC) guidelines. The main focus, as I see it, is to create an intravascular pressure, which by so doing will create a diffusion pressure of O2 into the tissues.

So, one gets called to a cardiac arrest victim.

1. Global overview

2. Open airway and check for breathing and do a pulse check at the same time.

3. Start compressions (comps are started before any vents in any case).

As I see it, at the point of collapse metabolism stops. As the partial pressure of O2 in the blood vessels needs to be higher than that in the tissues, the O2 that is in the blood will not diffuse into the tissues in the absence of any blood pressure. As such, whatever O2 was present in the blood and the lungs at the time of the collapse, will essentially still be there (I don't know the figures for the the rate at which O2 will just dissolve into blood). So, if one cracks on with good chest comps and develops an intravascular pressure sufficient to cause diffusion in to the tissues...there should be enough O2 still present to achieve something. I would think even more so in the case of FBAO, as essentially the lungs have been stoppered, and more O2 should remain within them.

So, having got the blood flowing again, now re-assess the airway. If there is a FBAO, magills and laryngoscope should be able to remove it quickly. Personally, if at all possible I would do this without interrupting chest comps. Then with an open airway, oxygenation can be started by whatever means is best in the given situation.

I am very much in favour of the new guidelines. I have always believed that good, un-interrupted chest comps, is one of the major keys to successful resuscitation.

Anyway, this is my take on the new guidelines...I am interested to hear other points of view.

Regards,

Stretchermonkey.

[jw-c152]

Although I have not taken an ACLS course as of yet, I didn't realize this was a new procedure...

Heart and Stroke Guidelines (here in Canada at least) for CPR - Unconscious FBAO have had 'chest compressions' rather than abdominal thrusts to clear the airway for over 5 years.... I don't think that concept is anything new.

[nussy]

i've noticed an interesting fact, surprisingly, right before the giudelines where (which most of them make seance) published new chest compresion instruments and chest compresion measuring instruments amerged, this is the same story as amiodorone Vs. lidocaine all over again, like every research, it depends on who wrote the study and why, and of course - what result was pleasable...

think about it...

[akflightmedic]

I have to disagree Nussy, chest compression instruments have been around for decades, you are too young to know about a thumper, heck I only got to use it a few times before it went to the way side. The newer versions have been out for several years and were heavily tested before being marketed like they are.

As for the new guidelines being published, no that is not the case. They were just released to the masses, they have been published for a while already.

Instructors or those who actively stay in the loop, knew about all these changes during the middle of last year. Now they are being rolled out to the mass providers.

I dont think there is any coorelation between the two however I have been wrong before.

[hammerpcp]

Although I have not taken an ACLS course as of yet, I didn't realize this was a new procedure...

Heart and Stroke Guidelines (here in Canada at least) for CPR - Unconscious FBAO have had 'chest compressions' rather than abdominal thrusts to clear the airway for over 5 years.... I don't think that concept is anything new.

Yep.