Cardiac Arrest Management Myths and Facts

With the roll out of the 2010 Cardiac Care Guidelines by the Canadian Heart and Stroke Association, I thought it advantageous to present a summary of the new guidelines, as well as an episode of EMS Mythbusters.

CPR

The 2010 guidelines focus on circulation as the priority in BLS and ALS patient management. Instead of ABC that we grew up with, it is now CAB. In the unresponsive patient, circulation is assessed first, followed by airway and breathing. The rate of compressions to ventilation's is still 30:2 but the rate should be greater than 100 per minute with a depth of 2 inches for adults and children. Exceptions would be infants who should only have 1" compression depth and infants/children can have a ratio of 15:2 when 2 person CPR is applied.



AED Use

The use of the AED has been expanded to infants of all age levels. Remember, for pediatric patients less than 8 years of age or 25kg, the Zoll attenuated peds pads should be used.
The AED should be attached and analysis performed on all pulseless patients without delay. The 2 minutes of CPR prior to attachment of the AED, is no longer recommended.

Advanced Airways

The use of an advanced airway (King LTD) during resuscitation is encouraged if the practitioner believes that the differential diagnosis is hypoxia that caused the arrest. Also, a greater emphasis will be placed on the measurement of quantitative end tidal CO2 during the arrest, in order to assess ventilation and pulmonary perfusion.

The primary care practitioner should become familiar with monitoring end tidal CO2 (capnography) beyond "yellow yay - purple poo". This is of course through the attachment of in line capnography, present in all of the Zolls. Check out this video bellow that explains this concept.






The following is a web cast that sums up basic and advanced interventions recommended in the 2010 guidelines.

Podcast

http://blog.emcrit.org/?powerpress_pinw=823-podcast


Podcast Notes

http://emcrit.org/1-resus/new-acls-guidelines.htm

We at YEMS hope to have these guidelines embedded into our program by the Spring. Also, capnography training will also be part of your continuing education in the near future.


Now For The Myth Busting

How do you remove excess body hair prior to placement of the multi-function pads?
Check this out.



What will you do?????

Airway Management Skills for Primary Care

Introduction

Yukon EMS utilizes a varied armamentarium of airway management tools in order to maintain or restore oxygenation and ventilation, in the patients we care for. The following is a series of tutorials collected for the purpose of augmenting the information presented in the skills section of the YEMS clinical guidelines. Also featured will be clinical pearls designed to augment practice in the lab setting as well as in the field.

Basic Airway Management

The foundation of advanced airway management is solid basic life support skills. The recognition of respiratory failure or arrest and intervening without delay, can mean the difference between stabilization and deterioration. An ability to competently manipulate the airway, place airway adjuncts and deliver effective positive pressure ventilation's with a bag valve mask, will buy the patient time until advanced equipment can be readied and applied.



The following are pearls specific to our program:

• Test the BVM for proper functioning during routine equipment checks.




• Mentally visualize location of equipment so that when it is require it can be obtained without thinking.




• Practice the skill on the airway management trainer and/or Stat Man regularly.

• In order to conserve O2, regulate oxygen so that reservoir remains partially inflated after compressing the BVM. Blindly turning the O2 regulator to 15LPM-25LPM will expend your O2 supply unnecessarily.

Blind Insertion Airway Device

The blind insertion airway device (BIAD) used by YEMS is the King LTD Airway. The King LTD is carried in both the ALS and BLS ground jump bags. Practitioners are to become equally familiar the device, and expected to use the King LTD when a rescue airway is necessary.

The rescue airway is to be employed by the primary care practitioner when bag and mask and airway adjuncts fails to adequately ventilate the patient or as a primary ventilation device when the use of a BVM and airway adjunct is impractical due to space and availability of trained hands when transporting the patient.




Additional Points:

• Place the instruction card on the patients chest in order to assist in remembering the sequence of steps in applying the device.




• Remember to auscultate lung sounds and assess chest rise and fall to confirm adequacy of ventilation.

• Additionally, verify ventilation with the colourometric end tidal CO2 detector device.
  

• Unless time is a factor (such as in the case of cardiac arrest), use the commercial Stabletube securing device instead of tape to secure the device externally.

Suctioning the King LTD Airway

Here is a demonstration of how to do this. You might know who the presenter is for this video.



Important Points

• Have the patient attached the to cardiac monitor and SpO2 monitor prior to suctioning.

• Measure the catheter from the tragus of the ear to the top of the King LTD.

• Insert the catheter without suction applied.

• Remove the catheter with a twisting motion with suction engaged.
  

• Suction for no longer than 10 seconds.

• Oxygenate prior and after each suction attempt.