Why is this answer right?

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jerellem

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This is a question off of a study guide for nremt-b. Also, when can you do CPR on a child with a pulse?

10. Your patient is a 10 year old girl who was pulled unconscious from a pool. Lifeguards have been performing assisted ventilations on her with high flow O2 for about 15 minutes. She is not breathing on her own or perfusing adequately and has a pulse rate of 55 bpm. What would be the proper course of action?



Your Answer: Attach the AED and analyze

Incorrect



Correct Answer is: Initiate chest compressions at 100 per minute



Other answers:

Increase the O2 flow rate to super high flow or 20 lpm

None of the above



Rationale: The newest AHA guidelines specify that a child who is not perfusing adequately, despite respiratory assistance, should receive chest compressions at 100 per minute.
 
jerellem said:
This is a question off of a study guide for nremt-b. Also, when can you do CPR on a child with a pulse?

10. Your patient is a 10 year old girl who was pulled unconscious from a pool. Lifeguards have been performing assisted ventilations on her with high flow O2 for about 15 minutes. She is not breathing on her own or perfusing adequately and has a pulse rate of 55 bpm. What would be the proper course of action?

AED won't do anything for that


Your Answer: Attach the AED and analyze

"...No shock advised"

Incorrect



Correct Answer is: Initiate chest compressions at 100 per minute



Other answers:

Increase the O2 flow rate to super high flow or 20 lpm

None of the above



Rationale: The newest AHA guidelines specify that a child who is not perfusing adequately, despite respiratory assistance, should receive chest compressions at 100 per minute.
Click to expand...


works for me
 
Ok, so when is CPR allowed on an adult or child WITH a pulse? And could your heart not beat at 55bpm in V-Fib?
 
No... you will not have a pulse in v-fib.
 
Children with a pulse under 60bpm are not properly perfusing the brain... so compressions are warranted. Go back to your CPR textbook for clarification.
 
emt.dan said:
Children with a pulse under 60bpm are not properly perfusing the brain... so compressions are warranted. Go back to your CPR textbook for clarification.
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At what point, if ever, would you assess for a rhythm?
 
MMiz said:
At what point, if ever, would you assess for a rhythm?
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Are you asking when you would use an AED or hook up a monitor?

the former... after 2 minutes of CPR you would reassess.

If the later... as soon as somebody had a free hand.
 
Well... this is awkward. I misread the prompt. Yep, I agree. Missed the small detail regarding the pulse rate. Small details will get ya.
 
Veneficus said:
Are you asking when you would use an AED or hook up a monitor?

the former... after 2 minutes of CPR you would reassess.

If the later... as soon as somebody had a free hand.
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Rephrase for me please :(
 
jerellem said:
Rephrase for me please :(
Click to expand...

upon completion of 2 minutes of CPR on this patient. Check breathing, Check pulse, If pulse still <60 continue CPR, if no pulse, continue CPR stoppoing only to aplly the AED.

If you have a manual monior defib. I would hook it up as soon as was practical without interrupting CPR.
 
Children are more rate dependent than adults are for maintaining cardiac output, and therefore, perfusion. The child in question may have a number of issues. She might be cold (hypothermic) and perhaps she's being inadequately oxygenated. Of the answers given, the more correct action is begin CPR to increase her cardiac output.
 
Velosprocket said:
I would think the patient being wet might have something to do with the answer too.
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Shouldn't, water on a Pt. should not deter AED use, wipe excess water from Pt. and proceed as normal.
 
Not adequate perfusion and low HR means correct the HR, which for peds tends to mean oxygen and compressions.
 
trevor1189 said:
Shouldn't, water on a Pt. should not deter AED use, wipe excess water from Pt. and proceed as normal.
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I was thinking more about the puddle of water the patient might be in. Sorry, my earlier response wasn't very clear. I'm interested in what might happen, if you use the AED on a patient in the rain, or kneeling in water. I can't seem to find a concrete answer.

http://www.redcross.org/www-files/Documents/pdf/Preparedness/AED_FAQs.pdf

Q. Is it safe to use AEDs around water?
A. Generally, the victim should not be in a puddle of water, nor should the rescuer be kneeling in a puddle of water when operating an AED. AEDs can be used in a variety of environments including rain and snow. Always use common sense when using an AED and follow the manufacturer’s recommendations.
 
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AED is already out of the question because the patient has a pulse, AED is only used on patients with no pulse whatsoever. You dont want to shock a living patient now do you, you might mess up the electrical activity in the heart and might even send the person into cardiac arrest
 
themooingdawg said:
AED is already out of the question because the patient has a pulse, AED is only used on patients with no pulse whatsoever. You dont want to shock a living patient now do you, you might mess up the electrical activity in the heart and might even send the person into cardiac arrest
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That's true, you do not want to shock a live patient. I hijacked the original question with my own AED questions.
 
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Are these Guidelines 2005 or the new, newest ones coming out at the end of the year?
 
OK, think and imagine. (By the way I don't disagree with ther answer)


AED: If you can't rapidly haul a ten year old to the lawn, or onto a spineboard as an insulator, you are a wimp (like me). Many AED"s can be used as a monittor also, can't they? The zap is not foreordained. Which leads to:

RATE: everyone seems (to me) to think you need a monitor for rate determination. Well, maybe; if the 55/min is irregular maybe a lot of activity is not making it to the ventricles or they are getting it but not firing. An irregular or weak 55 is a lot worse than a regular strong 55, especially if the pulse is readily palpated and confirmed at two locations. What is your pt's color, too?

SECONDARY CONSIDERATIONS: kids chill off faster than adults, especially if hauled out wet, but not enough to elicit mammalian diving reflex. Watch for gooseflesh, distal pallor and/or rubor. Also, if on dry concrete in the sun, get a thermal insulator like a towel between them and the deck to avoid an unintended painful stimulus (2nd deg burns, for instance).

TERMINOLOGY: odd use by the test authors for the concept "assisted respirations" when the pt is not spontaneously respiring. We called that "artificial respiration" in the good old days.
 
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Your rational of Zapping a patient into cardiac arrest, will not happen with an AED, as they only shock "the two shockable rhythms" You are correct in saying it's out of question because they have a pulse
 
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