Date Archives: 13-Apr-2017

Question: Hello, When a crew arrives on scene and finds a patient VSA, the ALS and BLS Standards require CPR per the HSFO guidelines at 30:2. When considering that there is strong evidence showing high quality CPR is the most important care to impact patient survival, my question revolves around what care or priorities should be considered when there are just the 2 paramedics on scene awaiting additional crews or resources.

The questions specifically are:

1) While Early defib, high-quality CPR and BVM ventilation's are a must, should an IV and medications be attempted with such limited resources? In attempting to do so, there is strong likelihood of compromising the quality of CPR because the compressor is doing about 2 compressions a second, and the 2nd medic is ventilating about every 15 seconds, thus making it next to impossible to perform any other tasks without diluting the CPR quality. This should the early defib, High-quality CPR and BVM ventilation's be the only focus until more resources show up, or should the IV and medication process be attempted to satisfy the requirements of the directive, even if doing so will compromise the CPR quality?

2) In regard to #1 above, when working in a rural setting, in which allied resources can sometimes take upwards of 20 minutes to arrive on scene, how does this play into the care?

3) As a given, I would love to be able to meet all the requirements of the ACP Cardiac arrest directive effectively, but with only 2 paramedics on scene the problem is there is just so much to do, and with quality of CPR and ventilation's/ETCO2 being able to be monitored and recorded, you can either violate the directive to maintain high-quality CPR, or risk having this data show your CPR quality was not great but got "everything done". Which is the preferred method of care?

4) While there is evidence supporting that CPR saves lives, is there any strong evidence supporting that the IV/Meds and the Advanced airways lead to better patient survival?

Question: Reviewing the STEMI bypass protocol I noticed that it requires 2mm of elevation in V1-V3 in two contiguous leads and 1mm of elevation in any other contiguous leads.

My question is then twofold:
1. What's different about V1-V3 that we require 2mm of elevation?
2. Why is V3 included in this since it is not anatomically contiguous with V1 or V2? Should then V4 not be included to give a "partner" to V3?

Thanks for your help!

Question: When attending to a medical VSA, where our monitor energy settings are preprogrammed (120J, 150J, 200J, 200J), if I happen to dump the first charge (non-shockable rhythm), should my second charge be at 120J or 150J? This second charge would be the first shock (assuming shockable rhythm), but the second analysis.

Question: Pushing a dose epinephrine seems to be very popular in the FOAM world for emergency physician. Its use has been promoted for things such as post cardiac arrest, refractory anaphylaxis, and severe bradycardia (some strong pharmacology reasons supporting it over atropine have been presented). Is this something you see being added to the advanced care paramedic treatment options at some point?

Question: I am just wondering if ASA is contraindicated for patients taking Pradaxa?

Question: While enroute to the emergency department with a VSA patient, if your patient presents in shockable rhythm (either new, or still in a shockable rhythm), can we continue to shock the patient without pulling over? My understanding of the reason for stopping was because we used to use semi-automated systems, and we did not want false interpretations based on artifact. But, if we are now interpreting the rhythm, and determine that it is a shockable rhythm, not artifact while in transit, shouldn't we be shocking?

The OBHG companion document states to stop when enroute using semi-automated system, no wording on manual defibrillation.