Dispatch: Man Down, Possible Cardiac Arrest

[rmellish]

there wasn't a long period between the stoppage of compressions and the shock.

i don't know for sure but aren't there basic meds that get pushed for all cpr's regardless of rhythm.


its been a few years since this has happened so i could be wrong on the sequence of events.

Epi and Atropine, but generally we try to defibrillate before the meds if it's a shockable rhythm.

 

[Ridryder911]

I'm just curious and not trying too nit pick at people, but I saw several posts saying they should be intubated right away. It had always been my opinion that an OPA and quality bagging would suffice while other things such as a monitor and defib would be slightly more needed than (and I'm being pescimistic here) fiddling around trying to place a tube, since that's a big controversy too, the whole successful intubation rate thing... But not to digress too much. My opinion is OPA and QUALITY bagging are good. While 2 medics would be ideal. It can be managed with 1, and I'd say 4 basics/FR.

... Ok, let the stoning commence for the intubation comment :blush:


p.s. If in a hospital, let's not forget to add the doc standing and checking a femoral through the process

Although theorotically it sounds great but I have usually seen more "fiddling" around with the monitor more than intubating. In a serious statement, my medics can intubate in less than 30 seconds after the intitial ventilation of the patient. Again, in a nice world a patient in cardiac arrest not to have vomited or will vomit would be great as well.

R/r 911

 

[exodus]

One driver, One monitoring rythm / shocking, Two for compressions (One of them, would get an IV and push drugs while the other is compressing), one to manage airway.

5 Total.

 

[MSDeltaFlt]

Here is a question for you on how your service gets dispatched for a possible cardiac arrest. This is obviously an ALS call so around here they dispatch a MICU (Paramedic and EMT). However, every cardiac arrest call I have heard additional manpower is requested on scene. I am not sure why they don't dispatch a minimum of two Paramedics and two EMTs for a CA call right from the start. This is something that I think definitely needs to be changed in my area. That way there is not a delay in getting a sufficient number of people on scene to work the code.

Seems like Paramedic 1, managing airway/intubating; Paramedic 2 getting IV started; EMT 1 chest compressions; EMT 2 getting the drugs out and assisting with getting a 12 lead going as well as checking vitals seems like it would be a good setup for these calls.

How many people do you think should be dispatched for a full arrest call?

Not necessarily. In my area you don't have a whole of help if any at all. Here's how it pans out ideally. One truck: Medic/Basic. They will work the code. They are primary. Second truck (if available): Medic/Basic. They will assist only. They will always remain availabe for another call. There have been many times the second truck shows up only to leave right back out of the house to go on another call. Frustrating but it happens.

You work the code (if workable) there in the house for 20min. If after 20min you can't get anything back but Asystole in >2 leads, you call it (after calling Med Control). If you get them back, then you transport. If anything else happens or when in doubt about anything, call Med Control.

As far as the intubation thingy goes, advanced airways are now further down the algorhythm. And even then they can be performed only if they do not interupt chest compressions.

 

[Ms.Medic]

i've only worked one cpr, and there were 3 medics and me as the basic, and another basic driving. i did compressions until fd got there and we loaded her up and off we went. during the transport there were no compressions being done. one medic was intubating, another got a line and pushed meds, and the other had her on the monitor to see what rhythm she had. all meds were pushed before they confirmed she was in vfib and one shock was applied that corrected it, so no need for compressions after that. i definitely not an expert but i saw that it worked great. the only words that were said was "she's in vfib" and "clear" other than that those 3 guys worked great together. obviously it would have been handled differently if she was in a different rhythm

Im confused on why there were meds pushed before they knew what was going on on the monitor, and also, why in the world there "were no compressions during transport" ??? Was she confirmed to be in vfib after transport started, and if so, how long after ?

 

[fma08]

Although theorotically it sounds great but I have usually seen more "fiddling" around with the monitor more than intubating. In a serious statement, my medics can intubate in less than 30 seconds after the intitial ventilation of the patient. Again, in a nice world a patient in cardiac arrest not to have vomited or will vomit would be great as well.

R/r 911

Quite a team there, they must get plenty of practice I'm assuming. ^_^

 

[amberdt03]

Im confused on why there were meds pushed before they knew what was going on on the monitor, and also, why in the world there "were no compressions during transport" ??? Was she confirmed to be in vfib after transport started, and if so, how long after ?

its been like 3 years since this call, so i could be wrong on the sequence of events. but i do remember that there were no compressions during transport after i stopped, so they could move her to the cot. they loaded her and as soon as the driver got in we took off. this happened in a busy flea market so it took approx 5-10 min before we could even get out onto the street. they had a line started and her on the monitor on her before we made it to the street and they shocked her, if i remember correctly, as we were turning on the street.

 

[amberdt03]

Epi and Atropine, but generally we try to defibrillate before the meds if it's a shockable rhythm.

thanks. i do remember that one of the medics did push epi and atropine.

 

[EMTinNEPA]

In my area, a cardiac arrest will usually result in a service "dumping the station". What this means is that EVERY single person in that station with medical training will go. Other members of that station will come from home. If need be, Fire Department will be dispatched for more manpower and PD will usually help out as well. One medic I worked with loved to have codes right at shift change, so the result would be a veritable EMS army (three or four crews) at his command. It usually worked out pretty well, as long as everybody involved has their heads about them.

 

[PapaBear434]

Lucas device !!!!!!!!!!!!! Its a beauty.

Never liked those things. Take too long to put on, and I don't like having to deal with the extra thing to check off in the morning.

Then, I have less than 15 minutes to a hospital no matter where I am in my city. You won't be doing compressions long.

 

[PapaBear434]

Three for a half arrest and four for a full arrest!

R/r 911

Half arrest? Is that like being kinda pregnant?

 

[lightsandsirens5]

Around here it is me and my partner. Maybe an LEO.:wacko:

 

[firecoins]

I will speculate that someone in half arrest is breathing but is in cardiac arrest.h34r:<_<







I am joking.

 

[daughertyemta]

i agree with you. Everyone wants to jump to intubation but remember ACLS! Intubation has been moved way down on the list. So if an OPA and bagging is sufficient for the time being if Im the only medic, then so be it! I think no more then 4. I worked for a service that you got an engine and a squad on almost every call.

 

[CAOX3]

i agree with you. Everyone wants to jump to intubation but remember ACLS! Intubation has been moved way down on the list. So if an OPA and bagging is sufficient for the time being if Im the only medic, then so be it! I think no more then 4. I worked for a service that you got an engine and a squad on almost every call.

Remember what about ACLS? That its been proven ineffective in survival rate of out of hospital cardiac arrest.

 

[Katie Elaine]

In my area, as well as several surrounding area ambulances, one ambulance is dispatched (we are an ALS ambulance, so we run with One EMT-I, one EMT-B, and then two other members that can be of any level), as well as an area paramedic that comes from out of town, and a fire engine with a crew. The ffs are used to grab backboards/anything extra we need from the ambulance, and to drive the ambulance if needed (but with the size of the crew and limited space in the back of the ambulance, we usually have extra EMTs to drive the ambulance and the medic car). This usually is a decent amount of people, but on the one possible arrest I went to, it was in tight quarters, so the surplus of people just got in the way, along with the countless nurses that were there (nursing home). All in all, extra people could be sent back to the engine/outside. So, it really all depends on how many ffs are dispatched to the scene, how many EMTs/Paramedics are on the crew, and how many other medical personel are also mixed in there.

 

[reaper]

Remember what about ACLS? That its been proven ineffective in survival rate of out of hospital cardiac arrest.

And your proof is where?

 

[CAOX3]

Im not doing your homework for you.

 

[reaper]

I don't have any homework! If you are going to make a claim, provide the proof to back it up!

 

[rmellish]

Remember what about ACLS? That its been proven ineffective in survival rate of out of hospital cardiac arrest.

Please define ineffective. Even with inhospital arrests the survival rate to discharge is low enough that the positive statistical effects of ACLS appear much smaller than many would expect.

Cardiac arrest survivability deals in such low percentages that to someone merely scanning the numbers, it might appear that ACLS makes little difference.

And no, I don't have the numbers in the back of my mind, or on hand. Sorry.