CPR Opinion

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Specializes in MICU, SICU, CICU.

Okay, I want any and all replies. Me and my mother (who is an RN 20+ yrs) have been havning this debate, and I want other opinions. My mom does ERT or emergency response team for a local hospital that provides ALS care for public events such as sporting events, concerts, etc. At one of these events an EMT team were walking through the event and a man collapsed pulses in front of them. They were carrying and AED and used it to shock him and he was conscious in minutes and actually tried to walk to the ambulance, they had to force him to get on the stretcher.

The issue, an observer (a retired nurse) called their medical director to report them for negligence for not performing CPR prior to defibrillation. I side with the EMTs I would have immediately defibrillated in accordince with AHA guidelines for early defibrillation.

Would you have performed CPR first or immediately defibrillated?

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I mentioned in another thread that I'm teaching CPR for the pro classes in addition to a bunch of other stuff for the Red Cross while I'm in school. The protocols that everyone (AHA, Red Cross, Joe's CPR school & laundromat) teach say that in you have an AED apply it and don't monkey around with CPR. This is standing order stuff. If a rescuer were to do otherwise he or she would be negligent and by not performing to the "standard of care" as set forth in the BLS protocols could be liable if things went bad for the patient.

aloha

Jim

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In a witnessed arrest with a defibrillaor RIGHT THERE, "Don't wait, DEFIBRILLATE"

If there is ANY delay...CPR

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Yep, that's what I was taught too. If the defibrillator is available, by all means use it:rolleyes:

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Specializes in CCRN, CNRN, Flight Nurse.
In a witnessed arrest with a defibrillaor RIGHT THERE, "Don't wait, DEFIBRILLATE"

If there is ANY delay...CPR

As an CPR Instructor, this is what I emphasize AND teach. In this case, it's a 'don't wait' situation.

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Specializes in MICU, SICU, CICU.

Again I share the prevailing opinion. What bugs me is that these EMTs are on the hot seat with the medical director, over the word of someone who is retired and not up to date on current AHA guidelines.

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They should not be in hot water, if their medical director actually knows what the current standards are. Inf the patient is in ventricular fibriallation, no matter how much CPR that you do, you are not going to get them out of it without either shocking or a pre-cordial thumb, if the AED was not available.

I have saved quite a few thru the years with the pre-cordial thumb, especially before the days of the AED, and if one is not available, and with VF, I will always try the thump. Too many are walking around because of it. You need something that will break that electrical activity that is not functioning properly.

And shame on that retired RN for not staying up to date. She is the one that should be in the hot seat.

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I just had CPR recert last week. That was a question I had missed on my test. According to AHA, you are supposed to perform CPR for 1 min, then defib, even if an AED is available. I did not agree with it either.

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Maybe they should ask the man who was saved what he thinks.

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Specializes in Hospice, Critical Care.

I thought the one minute of CPR was to allow the defibrillator to get to the scene. That CPR was a bridge until the defibrillator got there. If it was already there, USE it!

That retired nurse sounds like she has some real issues. A positive outcome and she's ticked off?!

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Yes, the rules are very silly...you are suppose to do 1 minute of CPR before...but that IS and WAS written to allow time for a AED to get there...(now I am assuming you mean the compressons or breathing end...remember CPR means look listen feel too before compressions/breathing, which I would assume your mother most certainly did...we Nurses can assess on a dime ya know ;) ).

The reason behind it also is the fact, as one could imagine, some pubic folks that have CPR training may not perform CPR if they know a AED is on the way..they may wait (out of fear, intimidation, or stupidity). Therefore it is a GUIDELINE, not a RULE...

Us that know our BLS/ACLS know..get that sucker on ASAP and get it going on! Heck..we also know that most AED's (basic models for the public) actually tell you if the heart is shockable or not...something a layman most often will not think about...most of them go breathing and pressing without thought to a very slow heart rate...or heck, breathing and pulse being present!!! (seen it so often!!!).

I have a feeling that nurse is a 'go strictly by the book' kind of nurse, and doesn't understand that the medics IN CHARGE of the scene make the call to best fit the situation and patient!

Heck...I worked with NW rock med, a volunteer medic organization that does indoor/outdoor events. Sorry, but being senior most cases, I would certainly choose an AED over CPR if able due to the fact I need to get that person on a backboard and out of a crowd QUICK (for scene safety as well as the patient and my safety!!! Ever do a code in a mosh pit? Then you would know what I mean!). Get a rhythm...then get em out! CPR will not give you the rhythm back..the shock will!!! (and if someone yells clear..believe you me, people MOVE!..that is if you can yell it above the music...).

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I always thought witnessed arrest called for immediate defib- or a beautiful precordial thump. Because in the case of a sudden collaspe there is a high percentage of shockable rhythms.

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