CPR Opinion

[Nurseboy1]

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?

[KatieBell]

Pre-cordial thump. Is actually you trying to defibrillate the patient without a defibrillator- I was so annoyed at a PA who the other night stood right beside a perfectly good defibrillator and tried to thump on the chest. (and the guy had a shockable "rhythm" Thing about the thump is you have to have a lot of "Power" and precision in it for it to work. In my case, I "thumped" a patient by accident while I was a student. He was on an unusual stretcher, and I was lowering it to start CPR and instead of just going down, it collasped, boom. It generated enough power to provide a Quasi Precoridal thump and actually got the rhythm going, but it wasn't actually a recommended action- just sort of a lucky coincidence. (And yes the physicians were impressed, I was just shocked.)

Anyway- the Precordial thump is still being taught- as a class II intervention- someitmes efective and not usually harmful in ACLS. But I really think most people do not have enough power to generate and its better to rely on a defibrillator...

[Daytonite, BSN, RN]

The guidelines are that if you witness the collapse and the person is pulseless, defibrillation is called for before beginning CPR. How was the call from the retired nurse handled by the medical director of the EMT's? I don't see how they could possibly have been disciplined. The retired nurse was just trying to be helpful, I guess, but if she's retired she probably isn't up on the latest with CPR.

[wtbcrna, MSN, DNP, CRNA]

Here guys,

http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf page 16 lower left hand corner.

Here is what the new AHA guideline states "Immediate defibrillation is appropriate for all rescuers responding to sudden witnessed collapse with an AED on site (for victims 1y/o or greater)."

[vampiregirl, BSN, RN]

I just thought I'd throw in my 2 cents from the EMS perspective. I agree that the EMT's were correct to immediately defibrillate due to it being a WITNESSED arrest. Our current EMS protocols use the AHA guidelines and this is what we do. However, our protocols also call for 3-4 minutes of CPR prior to defibrillating if the arrest was not witnessed or if the down time is greater than 4 minutes with no effective CPR in progress. The CPR allows for enough ATP to be generated to effectively convey the electric current. We have been using these protocols for a couple years now and have a 16% out of hospital save rate for our county, which isn't shabby considering the national save rate is ~4%.