I was thinking the other day how we could improve CPR even more from what we have and I began to think that in our area, we rarely do epi every time at the proper time, and many medics hold compression for a long time for intubation. What if we had a monitor that had a total code timer and a CPR timer. The total code timer would give an audible warning / notification of how long the code has been going since CPR was initiated, every two minutes. The CPR timer would stay at 0 unless compression stops, every 10 seconds it would give an audible CPR warning and the time. After 45 seconds or so an actual alarm like the v-tach alarm would go off until compression are resumed. All of the CPR alarms would also be logged so the data can be pulled for research / mortality studies as well.
How would you feel about immediate CPR notification / audible timers on a monitor?
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NomadicMedic
I know a guy who knows a guy.
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I use an interval timer on my iPhone.
MonkeyArrow
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I believe Zoll has a set of pads that has an integrated pressure pad that can judge compression depth and rate, as well as has a timer on there. I'm sure it wouldn't be too difficult to add a few extra features if the demand was there.
armydawg
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Great Ideas. Every heard of passive oxygenation? Also, is it policy for compressions to stop during intubation?
SeeNoMore
Old and Crappy
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I use a timer as well. We are expected to intubate during compressions without any interruption. This is nice when you do achieve ROSC and don't have to intubate the patient ... assuming we should even be intubating these patients at all. For a 15-20 minute transport it seems like a reasonable idea. Anyhow, I think your idea of finding ways of organizing the call is important. Choose what works for you and your team. It's a lot better than just randomly pushing Epi and doing CPR when the important work of "getting duh tube" has finished.
Our Zolls have the puck that will monitor your compression quality. But when we throw on the lucas the puck has to come off.
For the rest of that stuff, thats what fire is for.
SandpitMedic
Crowd pleaser
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Breath. Relax. Look at your watch. Turn on the metronome or have a team leader who actually monitors compressions. Don't be afraid to speak up.
reaper
Working Bum
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Exactly. Pit crew approach. Have a code leader to keep track of everything.
epipusher
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Phillips has something close to that.
So yes
Fire has that, we don't until next year at the earliest.
It isn't policy but some medics request it, as an basic I'm not going to refuse.
http://www.walmart.com/ip/Stouffer-s-Easy-Express-Garlic-Shrimp-Skillet-22-oz/19276033
Which one of you is from RivCo?
As far as the pit crew approach, they went over it for 30 mins in a meeting out here, as far as implementing it is BS. There needs to be an actual training on it and several scenarios presented.
As far as chilling on scene, full arrests are the chillest scenes for me, but I don't have the ability to check times, etc, because as a basic I'm always on compression unless we're in Palm Springs with the auto pulse. My partner also isn't the most receptive towards new research findings...
DesertMedic66
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Nah, never would have guessed haha.So yes
Fire has that, we don't until next year at the earliest.
It isn't policy but some medics request it, as an basic I'm not going to refuse.
http://www.walmart.com/ip/Stouffer-s-Easy-Express-Garlic-Shrimp-Skillet-22-oz/19276033
Which one of you is from RivCo?
As far as the pit crew approach, they went over it for 30 mins in a meeting out here, as far as implementing it is BS. There needs to be an actual training on it and several scenarios presented.
As far as chilling on scene, full arrests are the chillest scenes for me, but I don't have the ability to check times, etc, because as a basic I'm always on compression unless we're in Palm Springs with the auto pulse. My partner also isn't the most receptive towards new research findings...
Our training on the pit crew approach was extremely BS. There was zero practice on it and just a 10 minute PowerPoint. I don't feel comfortable using the pit crew approach due to lack of training so I don't use it as of right now and have never heard of anyone in the area using it.
We still have 90% of medics who will gladly stop compressions to attempt a tube multiple times. If the words King Airway are mentioned on scene you get awkward looks. It's so bad that we don't carry Kings in our response bags. So if we need a King we have to go back out to the unit to get it
SandpitMedic
Crowd pleaser
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I looooove garlic!
Now do your job, or go home and get your ****ing shine box!
Your job is to to compress... Not worry about times. ACLS is pit crew! As a basic, do what you're told and provide feedback as a team member. If you don't have ACLS, or don't run codes that often then perhaps you should be breaking out the scenario gear a little more often. Post-code you should be going over what went well and what did not.
Do your part... That is what pit crew is. What is difficult about that? And again, most monitors have metronomes to help you keep cadence with your compressions.
That's what you said- sounds like your group of "we" needs some skills practice and to not be all spun up. Refer to above about how to "improve" CPR.
Again, your job is to do your job. The medics know that they shouldn't be doing that. A timer on a computer doesn't need to tell them that.
A skilled medic should be able to intubate in most scenarios with compressions going, save for an extremely difficult airway.
Also, when you turn on the monitor--- there is a clock timer that starts ticking; most monitors also have software applications that allow times stamping of certain treatments.
My point is- codes are the easiest calls to run. Even codes that turn into multiple rhythms and all that jazz... Do your part. Keep cool. And just follow the damn recipe... Because in that case, that's really all it is. There is no wiz-bang top medic stuff other than having the knowledge of the latest ACLS guidelines and methods to best enhance survival, and the proper demeanor for scene control to ensure its done correctly. That includes manning the timer or watch and giving out direction in regards to times.
Now do your job, or go home and get your ****ing shine box!
Your job is to to compress... Not worry about times. ACLS is pit crew! As a basic, do what you're told and provide feedback as a team member. If you don't have ACLS, or don't run codes that often then perhaps you should be breaking out the scenario gear a little more often. Post-code you should be going over what went well and what did not.
Do your part... That is what pit crew is. What is difficult about that? And again, most monitors have metronomes to help you keep cadence with your compressions.
That's what you said- sounds like your group of "we" needs some skills practice and to not be all spun up. Refer to above about how to "improve" CPR.
Again, your job is to do your job. The medics know that they shouldn't be doing that. A timer on a computer doesn't need to tell them that.
A skilled medic should be able to intubate in most scenarios with compressions going, save for an extremely difficult airway.
Also, when you turn on the monitor--- there is a clock timer that starts ticking; most monitors also have software applications that allow times stamping of certain treatments.
My point is- codes are the easiest calls to run. Even codes that turn into multiple rhythms and all that jazz... Do your part. Keep cool. And just follow the damn recipe... Because in that case, that's really all it is. There is no wiz-bang top medic stuff other than having the knowledge of the latest ACLS guidelines and methods to best enhance survival, and the proper demeanor for scene control to ensure its done correctly. That includes manning the timer or watch and giving out direction in regards to times.
Underoath87
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Unfortunately, it sounds like one more gimmick that would complicate things more than help.
I wouldn't worry too much about the drug timing.
Just don't stop compressions for intubation (or limit the pause to a few seconds). We rarely even intubate codes anymore, as the iGel is the first-line airway in our code protocol (but we have RSI, so we still get to use ETT's).
I wouldn't worry too much about the drug timing.
Just don't stop compressions for intubation (or limit the pause to a few seconds). We rarely even intubate codes anymore, as the iGel is the first-line airway in our code protocol (but we have RSI, so we still get to use ETT's).
Bullets
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LP15 has a metronome, though i like the AED that has a timer that starts when the lid opens, so you can see how long youve had an AED applied, i think that is something that could be nice on a LP, maybe i just dont know how to get it
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I hope you're just being condescending to get a rise out of people, because this is absurd. My job is not just to do compressions. Maybe it is for some people, but there is no reason it has to be. If compressions have been stopped excessively, you can bet I'll be speaking up. There are two things that we know actually make a difference in arrests, compressions being one of them. If that's not happening, someone needs to speak up, regardless of certification of rank.
As for the whole pit crew thing, there are two key points to it and the rest of it can be modified to your needs. One is the code commander role, that needs to be filled and there should be one person calling the shots period. The other is that you need someone on deck to CPR at all times. When two minutes comes up, compressors switch. Not much more to it than that.
Most of our arrests are run with one paramedic, one ambulance EMT, and a bunch of firefighters who may have no medical training whatsoever besides a CPR card. We do just fine, in part because the ambulance EMT is expected to do more than compressions (get access, give meds, airway management).
SandpitMedic
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Yes. I was trying to get a rise.
My post is a long winded version of what @Underoath87 stated. One more bell or whistle isn't going to help, for it just becomes another "thing" getting in the way or mucking up the clarity of what to do. Plus, 3-5 minutes... There is wiggle room already.
Just stick to ACLS, everyone do their part, and be part of the team.
However, it is someone's job to watch the clock though... Might be yours.
My post is a long winded version of what @Underoath87 stated. One more bell or whistle isn't going to help, for it just becomes another "thing" getting in the way or mucking up the clarity of what to do. Plus, 3-5 minutes... There is wiggle room already.
Just stick to ACLS, everyone do their part, and be part of the team.
However, it is someone's job to watch the clock though... Might be yours.
Or you know, it could also be medics aren't realizing how long they are holding compressions and having a reminder could help. And how would it get i n the way if it's started automatically?
The whole pit crew thing would be awesome, if they actually did legitimate training on it out here with all the agencies at the same time.
Underoath87
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That reminder would be the guy currently assigned to compressions.
If I'm asked to hold compressions, I'll start again ASAP unless I have a good reason not to. So the only way compressions would be held for too long is if the medic in charge has forgotten how resuscitation works and keeps ordering me to hold compressions, which hasn't happened yet.