Case: Tourist drops in the Port Authority

[akroeze]

LMAO - dude...you play devils advocate well

Thank you

And you read too quick!

I updated my post to address Dust

[BushyFromOz]

Thank you

And you read too quick!

I updated my post to address Dust

lol - i was wondering how i managed to miss all of that writing :shock:

[Dustdevil]

Counter arguement would be that an SAED/AED would have likely shocked him as well.

Yep. But that's not really a counter. It's an agreement. Defibrillation of any kind is ALS care, regardless of who delivers it.

If not, then a few minutes of CPR may have made it coarse enough to shock, which if I am to understand correctly (could be wrong) has a higher chance of success anyway.

And monkeys might fly out his butt too. :roll:

Now you're just being silly with a bunch of pointless, "what if" bollocks.

[BushyFromOz]

Oh Dust!

And monkeys might fly out his butt too.

Im the resident self appointed monkey dude here

[akroeze]

Yep. But that's not really a counter. It's an agreement. Defibrillation of any kind is ALS care, regardless of who delivers it.

And monkeys might fly out his butt too. :roll:

Now you're just being silly with a bunch of pointless, "what if" bollocks.

Semantics I suppose and perhaps a false assumption on my part. When people say "BLS only is all you need" they generally mean CPR and defib. When they say ALS they mean ETT, IV, drugs, etc.

Sorry if I'm not using correct terminology but when I say BLS I include defib as a BLS procedure.

As far as going from fine to coarse, I thought that was a key point in upfront CPR vs. immediate defib? That 1-2 minutes of CPR tends to make fib more course due to increased myocardial oxygen levels.

[medic429]

Great story Asys!!

Good job!

[windsong]

You can say Devil's advocate, ok I maynot understand that reference but I believe God and Asy worked hand in hand with the help provided there. People amaze me when they are on the brink of death(deaths door) and all of a sudden, poof their back, just in time to celebrate Christmas.

Isnt God wonderful??

[BushyFromOz]

:shock: :? :roll: :!:

[Asysin2leads]

Its funny you mention the ALS/BLS debate towards cardiac arrests, because my partner and I were discussing it as well, and our latest CME journal article from one of our nice medical control physicians mentioned the debate.

I will definitely agree that a major part of this rescusitation was the early CPR. The early AED on the other hand, thats a little more complicated. As I mentioned before, the first rhythm I saw on the monitor was a fine v-fib, looking very much like the type that likes to jump to asystole when defibrillated. So, either the first AED shock didn't work, or he did return to a sinus rhythm but slipped back into v-fib prior to our arrival. Whether it helped or not can't really be known.

Interestingly enough, in our last CME lecture, our medical director had a great presentation on AED use. He showed a study over 10 years or so done in Seattle showed that after equipping all of their ambulances with defibrillators, the number of succesful rescusitations actually decreased. Why was this? Because people were coming upon cardiac arrest victims, throwing on the AED, and not doing CPR.

If they really are serious about going the "BLS only" route towards cardiac arrests (shudder), then they had better be making some major changes in the BLS curriculum and standards for certification. In my opinion, they should require as a condition of certification a physical test where you are required to perform CPR at an adequate rate and depth for 2 minutes, followed by a break for 2 minutes, on and off for 10-20 minutes. If you are unable to perform, you cannot be certified. I think this would cause about 50% or so of currently certified EMTs to lose their certification, especially the 75 pound five foot two girls who I could fit in one of the tech bags, or the 300 pound Denny's manager/EMT who sweats when he takes a blood pressure. In addition, a fully working code scenario involving CPR in transit should be required as a condition of certification, which each candidate having to give the required orders and instructions to participating observers/proctors ending with the patient being in the ambulance and transport initiated.

BLS may be the greatest factor in an arrest, I won't argue that point. But that doesn't mean that an ALS provider is not preferable to run a code. You haven't worked EMS until you've had five firefighters, two copsl and two EMTs turn to you and say "What should we do?"

[Timmy]

Well my first and so far only arrest was a 68 yo male at a folk rhythm festival.

He was down for about 30 seconds before we arrived. We started CPR, BVM got down an OPA and 1.5 minute in waked him with the SAED. Only took one shock and the defib told us our patient was alive. Took about 20mins for the Medics to arrive (remote area) Pt had nill hx, nill meds, looks healthy. Must have been dancing a little too hard! He managed to says “thanks” as we loaded him into the truck.

I hope all my arrests are as easy as this…

But yeah calls like this make you feel pretty cool lol… Good on yah Asys!