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?????
