lol those compressions look crazy man - she comes right off the chest a few times.

This looks so exciting but scary/stressful at the same time! I am nervous to see how I'll react during a code blue in my clinical.

@brendaandrade6753

2 жыл бұрын

Right

Also if a patient is unresponsive you can pretty much assume they are dead. No use wasting time checking for a pulse..if the patient is alive they will yell at you to get off their chest. Any time wasted not doing compressions increases chance for brain injury + death. This is mostly for inpatient advanced resuscitation. Also the defibrillator pad has an attachment that allows the compressor to assess whether compressions are fast enough and deep enough.

@becky2235

5 ай бұрын

Well why are we trained in drsabc then?

@HSK236

22 күн бұрын

​@@becky2235exactly bruh

One the positive side: 1) the code nurse entered the room and immediately identified herself 2) Code nurse immediately took control of the code and started directing the team what to do.( someone I know I would love to date) 3) They did four handed ventilations, best way for non-anaesthesia staff to ventilate

i'm watching random medical scenes for research in a scene i'm writing. this video is hilarious

So... as a very junior medical student, there's a few things I would like to dispute, at the risk of being ridiculed - NO WAY you can check ECGs whilst someone is doing CPR. The ECG probes are very sensitive and will show funky wave patterns whenever we have a heavy breathing patient trying to take a 12 lead due to chest movements, so imagine how crazy the waves will be when there's someone actively pressing on the chest. When we were doing resusc on actual patients, the code leader will call out "Pause for Rhythm Check" and then spend 2-3s to check ECGs for shockable rhythms - Not sure how great the evidence is for continuing compressions when there is a shockable rhythm, surely if there's a shockable rhythm then what patient needs would be electricity. We've already been compressing for the last 2-3 minutes, not sure what an additional 1.5 minutes of compression (as ordered by the code Doc) would do to change things around. Compressions aren't going to revert the rhythm, electricity may. - Not sure of the rationale for continuing compressions BEFORE rhythm check after a shock. If we've reverted him out of VT/Vfib into some form of SVT/sinus, then his heart can maintain some degree of output. Not sure how useful continuing CPR for another minute before checking the rhythm would be. If the rhythm is already in SVT/sinus, we should be able to avoid further compressions and get started on getting BP and bloodwork drawn to try and figure out what caused all of this. If the patient is not reverted out of VT/VFib, then checking rhythm for 2 seconds right after shock would probably also make just as much sense since we would know to continue CPR and set up for second round of drugs/electricity...

@DrSkawman

8 жыл бұрын

+Richard Tang Zoll has a CPR filter, so you can asses underlying rythm during chest compressions.

@jefflaabs9743

5 жыл бұрын

Dr Tang, Allow me to explain the rational behind why we do this. As you know, resuscitation success comes down to blood flow from high quality CPR. Even small pauses are detrimental to the patients outcomes. The small things that we didn’t think matter, matter! While I agree that in the electrical phase, a quick defib for early v-fib is warranted. Dr Davis loves great coronary blood flow immediately prior to defibrillation. It oxygenates the ischemic coronary muscle and removes lactic acid acid that builds up quickly during anerobic metabolism. If a heart is filled with lactate, it simply can contract. Only way to get rid of lactate is coronary perfusion. Stay on the chest. Regarding continuing Compressions immediately after a shock for a two minute cycle. Data shows that pts that are down longer than a few minutes have severely ischemic hearts. The heart muscle is full of lactic acid, depleted of O2 and just been stomped on and stunned with electricity. How likely is it that an ischemic heart will go from O% to 100% immediately after a shock? There is a very low likely hood that would happen for VF of a moderate duration 3-10 minutes. Recent data has shown a low likelihood of an ischemia heart starting a perfusing rhythm immediately following a shock. More likely pts would be shocked into a rhythm called “pseudo-pea”, where they have an organized rhythm, yet remain pulseless. If we stopes compressions immediately after that shock to check for pulses, we are starving that ischemic heart of O2/coronary blood flow, when it needs it the most. We are almost there, the engine needs a little More gas before it can start again. If you continue compressions immediately after a shock, we wouldn’t be starving the heart of coronary blood flow when it needs it the most. We hope that there would be a gradual resumption’s of effective contractions as you continue compressions. UCSD uses PetCo2 to assess CPR quality and whether or not the or has a pulse. In the video immediately after the shock, PetCo2 remained at 16mmhg. There is a low likely hood a human would have a pulse with a PetCo2 if 16 mmhg. If the pt achieved ROSC, the PetCo2 would immediately jump to above 35-45mmhg or higher. Anyway good questions.

@tc5028

Жыл бұрын

Yup!

great video guys and gals, good review for RNs who have not worked in the ED for a few years like myself.....thanks for posting.

Well organized, well done!!

she didnt re-tilt his head, insert a airway ajunct OR check for a pulse. She also didnt visually inspect the airway.

This type of CPR always for full recoil of the chest...UCSDMC has a zoll defribrillator that allows the team to view filtered ECG rhythm through the CPR artifact. Allows for CONTINUOUS uninterrupted CPR. The guy doing compressions is actually one of our code nurses. I find it funny everyone is judging this video but UCSDMC has one of the best survival rates for patients that have arrested..look it up. This hospital has their own advanced resuscitation training program that's different from ACLS

As an American Heart Association ACLS/BLS instructor, I'm appalled. Just a sad scenario!

@jefflaabs9743

9 жыл бұрын

Hi Ta M, This is a little embarrassing. If you have not heard, UCSD has the highest survival rates in Cali. Twice as high as any other UC system hospital. Awarded JACHOs award for best resuscitation practices in 2013. Is this because they suck? Please slow down and don't just buy into the AHA is the only way thing. Please, I beg you to be open minded and think deeper. UCSD has Chest Compression Fractions of >92%. AHA ACLS and PALS courses have significant issues. I would like to help you understand this so you can take this to your students. Please ask me ANY question about this scenario and I will clarify for you. If you're like me, you're hungry for knowledge. These are small changes to the standard AHA guidelines. They just made it better. I would love to help you understand. I will respond to any questions you have. Jeff

@rociozuniga8900

5 жыл бұрын

@@jefflaabs9743 cj, iii97ubnmmloollo

@rociozuniga8900

5 жыл бұрын

@@jefflaabs9743 QC x z ,

Rescuers are supposed to lean forward with their shoulders directly over outstretched hands that is to lean forward until the body reaches natural imbalance- where there is a sensation of falling forward if the arms and hands were not providing support. The thrust for each compression should come from the TRUNK and not the wrist which makes it bouncy and u will not get maximum effect.

Dr Davis is AWESOME :)

Thank you for taking the time to make this, good review for ACLS.

How is the doctor recognising a change in rhythm whilst CPR is in process?? And in 10 years of emergency nursing, have never seen CPR like that.

Good job!

d code nurse is so dominating.. finger pointing d code MD haha nice

Too funny.... and that is the reason I'm on here, trying to figure out how to write an intense medical scene with my patient arresting.

Didn't check for pulse before starting compressions lol

Lol, loved it when the doc asked for anesthesia!

@oliverlahr2688

2 жыл бұрын

surely drinking coffee 🙂

Nice to see there aren't 25+ people getting in each other's way. I call it wolfpacking. Meaning everyone wants to jump in and be part of it . I've alwaysays said 4 is all that's needed to run a code. I've witnessed a 18D (Special Forces Medic) run one solo during combat operations.

Respiratory on point

Everytime you bag you decrease venous return. It bothers me so much when I see a RT bag way to fast and just squeezes the whole bag. Every 6-8 seconds and stop when you have chest rise. Or pop the lung, whatever. I'm a DNR, so I don't really care.

How come we never get dramatic background music on a code?

video looked awesome. I'd check an apical pulse before calling a code though. All in all i liked it

nice code cart

I encourage anyone who has a chance to take UCSDMC's ART/BART training..it's pretty amazing. I myself as a new nurse at UCSD am pretty impressed.

CPR 30 chest compressions rate 100/min, 2 breaths- stop to give breaths or lungs will not expand and breaths are useless. Bed absorbed compressions need back board. Do CPR before shocking AED is set up and rhythm has been assessed shock my be given. Often medications are given before shocking. Make sure every one is clear sure touching the patient may not shock you but if you touch any metal you may be the electrical ground. For non medical CPR now breaths are not involved and it is compression only because circulating blood that has oxygen in it is more important than trying to add oxygen in. My 2 cents.

I CAN SO RELATE!!!..nice one

@noid2209

4 жыл бұрын

Will you please check my blood pressure and pulse rate?

this is the funniest video i ever seen lol

However there are a few things I could take away from this -- mainly regarding transitions and flow 1) I may not have recoiled my hands very much during compressions, since I was initially taught and learned via watching to go hard and fast. I did read something about recoil being just as important though, so I will keep that in mind for the future 2) I should probably transition better with the nurses when switching off CPR, didn't do the whole 3... 2... 1... thing. Not sure how much evidence there is for that, since I doubt the 1-2 second delay will drastically change the trajectory but always nice to make things travel smoother

More postive: 4) Used OPA and suctioned patient 5) The physician entered and immediately introduced himself 6) Physician was concerned about the quality of CPR and switched the compressors 7) compressors switched very quick. Compression - Shock - Compressions very nice very fast 9) Using pulse ox wave form to help with ROSC

@evansharp3931

Жыл бұрын

Ok wait he squeezes the ambu bag to hard and you can cause the patient to vomit everything’s good

Anyone wanna mention porters or wardsmen ... im a theatre porter or theatre orderly , whatever you wanna call me. I have had to do this on various occasions. I feel that the orderlys are runners. It is my duty to run the resus trolly to theatre and assist on CPR.

good job justin

@allinonesolutionscafe7614

6 жыл бұрын

acrpus99

Very quick response

place back board first before doing chest compression.Poor chest compression, it should be arms straight and hands not lifted...

If you are not a paramedic or anything related to that, just shut up and let these people do their jobs. scott amadon Pulse check is not a priority. As a paramedic you can check pulsations of the carotid artery (more palpable in most cases) but in many cases the radial artery isn't even palpabel because of the low cardiac output (if there is any), also, in elderly people, you hardly ever feel the radial artery when they're alive... so also for that reason it really isn't an accurate thing to decide whether someone is dead or not (half of the geriatric unit would be dead then ). Check breathing and thorax movement is more effective/accurate and will make sure you don't spend time looking for pulsations on the wrist because sometimes it's just hard to find/feel. By that time, your patient will be dead. Also, we learn not-paramedics not to search for a pulse because they often don't have the experience and knowledge to know where it is located, so that would also be a waste of time.

she did not check the pulse first

Are these chest compressions effective?

The two nurse don't now how to do cpr my god..

@pandapuffcloud1426

3 жыл бұрын

For real. They are more likely to loose a patient like that

I'm not trying to be a smartass but they didn't check the rhythm? What if it's shockable? Aren't you supposed to check rhythm and see if it's shockable and then going through 5 cycles of CPR before administering any drugs? Also, that's pretty poor CPR. They gave epi, vasopressin and considered the 5H's and 5T's all within 1 cycle of CPR?!

Not once in any of these videos did anyone check a pulse before beginning compressions.Mid teens on end tidal= To fast for ventalations. Not good.

New CPR and ACLS guidelines

I hate to be judgemental, but pretty poor chest compressions! Need straight arms, perpendicular force and your hands not lifting off the chest. Cool scenario though!

Giving breaths while doing compression's?!

@pandapuffcloud1426

3 жыл бұрын

I was thinking the same thing.

educational

I would rather call this "the WRONG stuff"

Wow she needs to work on her compressions

@ivanduong yup..Agreed. I never learned compressions like this either. They Never checked for an apical or carotid pulse. Ive been to many codes and this is not how it goes down. I dont know but we have to recert every year for CPR and i would fail if i ever did compressions like this

Oh the compressions...

When the nurse or doctor was checking for breathing she didn’t look for a paulse and she wasn’t checking for 10 seconds

this compression was good ok people keep calm and stop talking like doctors from Dr House serial

I've seen better compressions in movies! LOL

Good Job, for my friends but you must Evaluation this Video Demostration Just Suggestion: 1. Sufficient ventilation of the nurse 2. The leader immediately give epinephrine, should wait 2 minutes cpr granted. 3. all cpr wrong, should learn cpr again. learn cpr correct 4. enter the wrong leader oropharyngeal 5. turn cpr, second nurse must take the position of the hand next to the nurse cpr first 6. Leader if you want to give Shock, shall have to see description heart rhythm is monitored and should see your friends friends around him, ARE YOU CLEAR if new CLEAR in SHOCK. 7. The doctor did not check when the picture on the monitor Nadi sinus rythem

isn't it that you give compressions atleast 2mins and check the rythm? just askin...

Is she making a dough for baklava or compressing the chest at 0:58?? Who does it this way? Your whole upper body should participate during heart massage.

they didn't evaluate the rhytm wrong compressions

By the way, Jeff Laabs...Thank you for your input on this vid. Fortunately this method of CPR and ALS is starting to be used in my state and country because it is recognised for its superior survival rates in code blues. (Notwithstanding the adage 'any CPR is better than no CPR)

Too many things wrong to mention. Really shocked a well known medical center like UC put a video of a code being run so poorly. lol

It was a reconstruction I think

the pulse checking should be more than 5 secs but less than 10 secs.and she said "he is not breathing "if no breath,what should we do ?start CPR?

@devidimalibot9253

10 жыл бұрын

Yeah, i did not see her checking the pulse :)

@notimecryyang4004

10 жыл бұрын

so did i

@jefflaabs9743

10 жыл бұрын

In basic Heartsaver CPR, AHA teaches lay rescuers to not check pulses in cardiac arrest, but to look for breathing and if no breathing, immediately start chest compressions. The reason is if someone is not breathing, that is one of the first signs their dead. UCSD uses this concept.

@jefflaabs9743

10 жыл бұрын

Nathan Yellico , Pulse checks by physicians have been documented to be wrong around 25% of the time. I realize these people are not lay rescuers. The reference to lay rescuers was to point out the the AHA does encourage people to not check pulses prior to starting CPR. UCSD also looks at the general appearance of the patient. If they look dead, no breathing, bad skin signs, USCD starts CPR. If its just a respiratory arrest, of course they would not start CPR, rather they would perform rescue breathing. UCSD is on the chest 90+% of the time. Taking 10 seconds of the chest to analyze pulses contributes to the hands of time that we all worry about. UCSD has the highest survival rates in Ca. Look it up. JACHO just awarded them "best practice" for resuscitation in 2013. Please look up there program. Its called "advanced Resuscitation training, Basic Resuscitation Training, Pediatric advanced Resuscitation training. These are AHA alternatives. Do the numbers. It takes 15 seconds to perform 30 compressions. Then two breaths takes a minimum of 5 seconds of hands off time. if you do 5 cycles in one minute that's 25 seconds off hands off time. Now add the 10 seconds for the pulse check. Poof, now your at 35 seconds hands off time. Please note: this is just compressions, ventilations and a pulse check. It does not include defibrillation, rhythm analysis, IV, intubation or any of the other 20 things we do that cause us to be off the chest. I hope you will respond...

Low quality chest compression.

@angelap7038

6 жыл бұрын

paradee TheDreamer 113/0

@jefflaabs9743

5 жыл бұрын

That’s called the five finger fulcrum technique. It’s been extensively studied and allow’s full recoil almost 100% of the time. I would encourage you to read up on it and hopefully try it.

That poor dummy

Assess pt, call code blue, begin bls. ABC, Iv , Monitor. Bag q6 secs to chest rise (q1sec in peds) Meds:q3 min. (epi 1 mg, consider vasopressin 40 u iv once only) Shock:q2 min (200 J once with thenew biphasics) Consider: ampD50, bolus fluids, mag 2 grams of torsades, if hyperkalemia=5 u R insulin and amp d50, procainimide 100 mg IV

did they save him?

I was in a hospital an they called a code blue

This would have been much better without the music!!!

I want more videos like this one. I want more Simman.

Wait wait, CPR and didn't check a pulse?

This is not AHA guidelines for 2010. The patient should have had CPR started then defib if in VF or VT. Epi is not pushed on the first round.

She was doing compressions longer than him and hes like can we switch wah wah wah boo hoo

The Wrong Stuff..

@jetsontherise Yeah, go for it.

Compressions are crap. Way to destroy your wrists too!

A doll... Seriously...

lmao, worst CPR i've seen TO DATE!

Really? She didn't check for a pulse? No compression board under the patient AND they gave epi way too soon. This guy didn't make it.

Of course he's not breathing, he's choked on all that hair you keep putting in his face. Never seen a nurse with hair all over a patient's face like that. Good God, we'd be sacked on the spot!

Why taking so long to shock? 🤔who’s the recorder? No clear roles 🙄

I think that they are doing CPR wrong, too fast.

Poor chest compressions technique

Walk in, say patients name, if they dont respond in 2 seconds, start compressions!?? Bahaha I would be doing cpr on every single patient

iv line insertion skipped

@jefflaabs9743

9 жыл бұрын

Wrong! Iv was already in the patient. Look at the first 10 seconds of the video. Attention to detail is crucial. Thank you.

Nice compression...not.

slenderman

@chrissline77 Well that would be your mistake, as I am actually in the medical field. No need for ad hominem attacks...

Number of things I do differently, how about opa first then bag then intubate among other things I see wrong, must be some clinic ER,lol..... seems where all critics of everyone though.

That is the worst CPR ever. Not deep enough, too much bounce, also compressions should come from the force of the upper body forcing downward instead of coming from a push motion.

she should have checked the pulse first. and given the AED shock before epinephrine . please remove this video as it is not according to the new guidelines.

😂

😯

Dios mío, y como hacen en nuestros países que ni jeringas hay en estos casos?.

Limp fish quality compressions

shit compressions, gaduel airway must be inserted prior to bag valve masking,

Well I'm not going to UC San Diego for medical school those were awful chest compressions.

what the hell is that compression?!!!! anyway, a bad compression is better than no compression at all. But seriously, that nurse needs to redo her BLS skills

shes not even compressing right...?

Misc: 1) They were doing 10:1 compressions to breaths with BVM. AHA uses 30:2, however, Some paramedics HP crews have switched from 30:2 with ventilation pause to 10:1 and don’t pause for ventilations. 2) They are using ETCO2 with BVM. You will get readings that will be inaccurate due to mask dead space and any mask leakage…. Nice to have some info just remember it will be somewhat off and has only be recommended for ETT.

Fuck it, just call it ..

That’s a dummy