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?
LOVE those thumps...I wittnessed two arrests, and that little jobbie saved them :). They are very under rated...just be careful when you use them .
I am a nursing student, I have taken a number of CPR, defib, O2 admin, 1st aid, wilderness 1st aid, industrial first aid, advanced first aid (you get the picture). The few times I have seen this question asked, the answer was evaluate, then defib if possible. My own paper work is in progress to get my certs to teach those, and they (American EHS) told me defib first, I called.
What level of training (the standard is clear that you dont just thump on someones chest w/o special training) do I have to get to to learn the precortical thump? Is it at ACLS or when?
Also when I first read about precort thumps here, I did some research and most of the recent lit. shows the precort thump to provide little to no benefit. but the anecdotal evidence you all provide here seems to overwhelmingly support it.
Also; is it appropriate for me to take BLS this time instead of the CPR the school requires? or in addition too, or not at all untill after I have my license?
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.
Actually I represent AHA, and this is incorrect, do you remember the question # and what test version?
The others are correct, if you have the AED, by all means attach it and follow the instructions, you cannot perform CPR or touch the patient while the AED is analyzing, if the AED instructs to begin CPR after analyzing, do just that until additional help arrives.
Specializes in Education, Acute, Med/Surg, Tele, etc.
I would go with BLS if not ACLS! It is never a bad thing to know what all is going on in a code..even if you don't perform it...at least you know the progression and treatments being done, and in some cases, assist by getting supplies for those doing the actual treatment! I have been in situations where I was able to help get supplies, hold IV lines, and assist where seconds count...I would only know to do this if I knew what they were going to do...
As far as the precord thump...I learned that by my hubby (paramedic). In cases of witnessed arrest, if you are fortunate enough to get to the heart just as it is FIRST stopped, it can shock the body and get it back running, usually not fully..but every second counts, and one with a pulse counts more! Both Pts I had had SEVERE bradycardia (both the toliet MI's if you know what I mean...brady on the toliet from vagal stimulation from pressing too hard), and I was able to get to that crutial moment...elbow rested (not pressing!) near the umbilicus or upper gastric area for a mark, swift thump (NOT HIT) to the cardiac apex...and viola!~ (a thump is a dull thwap and immediate withdrawl). But any paramedic will tell you...I got lucky, but for me...lighting struck twice for me :)....
Of course other trainings will tell you different ways..but I am so darn short, and my arms too..this works best for me!
Also, I had to be very careful due to the fact my residents were in their 90's and very fragile at that...but like I say...no pulse, no breathing...the patient is dead..so whatever you do within your training to assist...is a bonus! Sorry, but a person will not really mind a thump or even a broken rib or two if they are dead...we can only make amends with that if they make it..and we do!
I would go with BLS if not ACLS! It is never a bad thing to know what all is going on in a code..even if you don't perform it...at least you know the progression and treatments being done, and in some cases, assist by getting supplies for those doing the actual treatment! I have been in situations where I was able to help get supplies, hold IV lines, and assist where seconds count...I would only know to do this if I knew what they were going to do...
Well, I did check out ACLS but I dont see that I will really get much benefit from that untill I have (or nearly) graduated. I dont think I am even allowed to take it at this point.
But I think I will do BLS. CPR is pretty boring after about the 20 some times I have taken it. of course as an insturctor I guess i cancertify myself!!
Specializes in Education, Acute, Med/Surg, Tele, etc.
That reminds me of another story acutally...one about guidelines and rules that do interfer with treatments of choice.
One day I was at a mall and this woman dropped to the floor. I rushed to her and assessed quickly...was breathing/heartrate slow but normal and steady (I won't go into all the other things)...and she was alert and talking.
Then some newbie paramedics were there (with their senior who let them handle this one..I would too). They actually flipped out and just about stopped everything (including their assessment) because they didn't have a pulse ox! I told them not to worry..that her O2 sats may be low, but okay for her.
They looked at me like I was the biggest idiot on the face of the earth. One, with much sarcasm in their voice asked me how I knew...
"Simple..they are alert and oriented, talking, and breathing! No cyanosis..even the toes...I think we can now bypass the pulse ox test, get some O's on her for safety, and move on now!".
The senior paramedic then said "good lesson kiddos...assess your patient not a machine!" then thanked me!
Could you imagine if they had stopped during a severe acute asthma attack to find the pulse ox??? Uhggggg! Treatment of choice is O's...and start low if you aren't sure..and for goodness sakes, if you do the very very rare hypoxic drive situation....heck...you have the tubes, get to it!
That situation will always stand out in my mind...and I have forever been a severe advocate of using machines as tools when needed (some more than others like an AED!), but actually take your mind off that for a moment to assess the actual pt!!!!!
Specializes in Education, Acute, Med/Surg, Tele, etc.
I took ACLS in school :), but then again..hubby being a paramedic and all..I had connections to get it. IT helped me out..but mostly I only did BLS...so good choice to stick with that. Heck..LOL, costs less and for a student..that is a good thing!
Continued sucess to you...and have fun while you are doing it :)
What level of training (the standard is clear that you dont just thump on someones chest w/o special training) do I have to get to to learn the precortical thump? Is it at ACLS or when?
Precortical thump is no longer taught. It went out over 10 or 15 years ago.
When I took CPR (non-prefessional) for the first time (late 70s or early 80s), I was in one of the last classes that still taught precordial thump. We were told then that it would soon be phased out, even though it was useful and often proved effective.
Why? Because many people--docs included--thought that if one thump was good, two or three or half a dozen should be even better. They didn't limit the thump to witnessed arrests. And they didn't use proper landmarks. So for every correct use of the thump (regardless of outcome), there were at least several (and perhaps many) other attempts where folks were coming upon someone who had been down for who knows how long and pounding away, indiscriminately and repeatedly, on the poor victim's chest, as if to say, "Live, dammit, live!" While it looked dramatic, it almost never worked, it delayed the more effective measure of CPR (no defib for civilians back then), and it ruffled the feathers of family members who saw total strangers slamming the heck out of poor Aunt Susie or Uncle Lou.
An effective precordial (the correct spelling) thump is a single blow delivered to the apex of the heart of a patient whose arrest has just taken place. Anything outside that narrow parameter is just a whack on the chest.
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Antikigirl, ASN, RN
2,595 Posts
LOVE those thumps...I wittnessed two arrests, and that little jobbie saved them :). They are very under rated...just be careful when you use them
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