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Old 05-19-2011, 12:47 AM   #11
systemet
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Quote:
Originally Posted by BEorP View Post
From the 2010 Guidelines:
"After shock delivery, the rescuer should not delay resumption of chest compressions to recheck the rhythm or pulse. After about 5 cycles of CPR (about 2 minutes, although this time is not firm), ideally ending with compressions, the AED should then analyze the cardiac rhythm and deliver another shock if indicated (Class I, LOE B). If a nonshockable rhythm is detected, the AED should instruct the rescuer to resume CPR immediately, beginning with chest compressions (Class I, LOE B)."

Class I is the highest class of recommendation and Level of Evidence B means that this is based on "Data derived from a single randomized trial, or non-randomized studies".
Well, that's embarrassing. I guess I should have taken 5 seconds to just check the guidelines. I find the study (or studies) and report back.


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Old 05-20-2011, 02:21 PM   #12
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It's funny cause this same question came into play about two weeks ago when we did an AED skills test. Funny how it was the MEDIC student that instructed us stupid BLS providers to check pulses after first shock. Good luck to you OP! I am glad some people where able to be respectful and answer your question(s).
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Old 05-20-2011, 07:07 PM   #13
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Not to get too off topic here but...

We also need to think about how proficient in "pulse locating" we aren't.
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Old 05-23-2011, 09:58 AM   #14
medtech421
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Stop CPR after your patient says "ouch" the second time. Compressions might become detrimental after that.
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Old 05-25-2011, 03:57 AM   #15
korvus
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I don't have an actual reference in front of me, but I recall hearing that even if a shock works, it's common to get several seconds of asystole before the heart starts up again, so even if you do a pulse check, you probably won't detect anything even if the shock "worked". Add that to the previous comments about CPR not really hurting a beating heart, and emphasis on limiting breaks in compressions, and it all makes sense.
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Old 05-25-2011, 03:35 PM   #16
medtech421
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Originally Posted by korvus View Post
I don't have an actual reference in front of me, but I recall hearing that even if a shock works, it's common to get several seconds of asystole before the heart starts up again, so even if you do a pulse check, you probably won't detect anything even if the shock "worked". Add that to the previous comments about CPR not really hurting a beating heart, and emphasis on limiting breaks in compressions, and it all makes sense.
I seem to remember in my last instructor update..they said even if a pulse is obtained, you should do compressions because there is a high chance it will stop after a minute or so..thereby causing reports of "we lost him a couple of times"
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Old 05-29-2011, 12:15 AM   #17
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Quote:
Originally Posted by medtech421 View Post
Stop CPR after your patient says "ouch" the second time. Compressions might become detrimental after that.
And not just detrimental to you... the Patient might get a little testy, particularly if you sohuldn't have started in the first place..
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Old 06-07-2011, 02:49 PM   #18
EMTswag
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I was always taught that the only reassessment of pulse was when ordered by ALS or an obvious return of circulation. I think the time saved by immediately returning to compressions in the event that they are still in a shockable rhythm outweigh the risks of compressions on someone that had returned to normal sinus.
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Old 07-08-2011, 05:01 AM   #19
TacEMT
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Just to confirm, after giving a shock with an AED, you immediately continues with CPR? No pulse check.
You keep going with chest compressions and ventilations (30:2) for 2 minutes. Then you check pulse, and if you get a pulse, check breathing. If you find a pulse, you assist with ventilations. If there is no pulse you continue with CPR.

And lets say the AED analyzes and give a no shock. Then you check pulse, and check breathing.

Is this correct?
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Old 07-08-2011, 05:25 AM   #20
Handsome Robb
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CPR with the patient hooked up to an AED is pretty simple as it tells you what to do. If a shock is advised, deliver the shock then continue compressions. No shock advised it'll tell you to "Check pulse. If no pulse present continue CPR" Pulse present? Support ventilations until adequate and monitor the pulse. Not present, continue compressions.

So yes, you are correct. The thought is, even if the shock restarts the heart, it still needs help circulating oxygenated blood right after it starts back up.
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