AUT diploma graduate here, I've been trained to do HP CPR according to this model, and even achieved ROSC on one of my frontline jobs this way... however, now that I'm working as an ambulance officer in the Cook Islands, I get told that 'my' method is incorrect, particularly the new palm-lifting technique, and that what I learn 'in the classroom' is different from 'real life.' There is a lack of standardized medical training here in the Cooks, and the ambulance department is relatively underdeveloped, so I find it frustrating that new information is getting discouraged. I hope that someday we can bring our system up to date with this model!

@samcherylarmstrong2943

2 жыл бұрын

Good call! Lifting your hands off of the chest promotes faster recoil velocity. We've been learning "Allow Complete Recoil" forever, but it's just something that seems to be said in passing. In reality it is the key to coronary artery perfusion. The heart (and the rest of the organs) don't like high pressure. outside of the aortic valve is where the coronary arteries originate, but they aren't open during systole (CPR Compression). When the valve closes, the coronary arteries receive blood. This is promoted by two things. 1. Diastolic pressure. 2. Negative pressure pulling from the right side of the heart while the heart muscle returns to it's pre-compression form. If there is even a little bit of positive pressure on the chest blood flow through the heart doesn't happen. Let's say that you see me on the side of the road with my car hood up. I say it won't start and ask if you can help me with jumper cables? We connect it but it still won't start. (This next part is called the Male Intelligence Test) - You ask if you can give it a try - (As if you turn a key more skillfully than I do). Something profound happens while you're NOT getting a response. You notice that the fuel gauge says that the car is empty. Regardless of the electricity, It's not going to start. This is the same as the heart. ATP = Fuel! Without circulation created by CPR (with complete recoil to promote cardiac perfusion) ATP levels diminish and any potential shockable rhythm (Course Ventricular Fibrillation) falls to lower level (Fine Ventricular Fibrillation), and then to the worst possible option, Nothing (Asystole). If we shock it, most times Fine V-Fib will drop to PEA or Asystole. Great, our efforts for resuscitation just...Didn't. High performance CPR with COMPLETE RECOIL, as you're doing by ensuring that your hands leave the chest, gives the best chance to maintain Course V-Fib, keep fuel in the tank, and reset the system. Keep doing what you're doing. We've been following the blind sheep for too long! Consider this, we do 30 compressions in 15 seconds. It takes 16 seconds to reach perfusion pressure, and 3 seconds for it to drop to nearly zero (2 Breaths). So it's not that we're...Um...We're just not resuscitating them. For 19 second we do one round of nearly nothing, then we follow it with another round, and another. Maybe this is why there are people promoting "Compressions Only" continuous CPR, with passive oxygenation until intubation. WHEN WAS THE LAST TIME YOUR HEART TOOK A 3 SECOND, OR 19 SECOND BREAK? Mine doesn't, and the guy on the ground has enough problems that got him on the ground in the first place. Let's not make it worse by not promoting continuous perfusion to transport all the goodies our cells need to fight to stay alive. Resuscitation efforts fail around 90% of the time. Name one other occupation that doesn't fire you with that lack of success. We can all do better! Good Luck and I hope you have great success.

Great video. Will be good to put this into practice and see the formal teaching at CCE. Let's see that ROSC and discharge from the hospital rate increase, look forward to seeing the broader application and @NZRC adoption in teaching of CPR.

@autparamedicine5336

5 жыл бұрын

Thank you Craig, we are all looking forward to seeing positive outcomes for patients from these changes!

Great video, and even better to see all the Emergency Services coming to that common goal of a single unified process for the country on CPR. This would be one to share so that "anyone" out there can be in the right place, at the right time, and help to save a life.

Most informative, great job, many thanks UK

Great video, awesome job guys :D

Am I correct that in cases of asthma, hanging or drowning arrests there is to be a physical stop during ventilations at 15:2 instead of continuous compressions after lmao placement displayed in this video?

Lucas had the same idear many years ago so they developed a machine for it pretty much every ambulance in Holland has one kzread.info/dash/bejne/Z66Ep6Ozp9rNkaw.html Might be something for the future

why are they not clearing before defibrillation? They only hover their hands but their knees still touch the patient.

@autparamedicine7644

5 жыл бұрын

Some people will need to be right up against the patient in order to position their shoulders over the centre of the patient's chest. Even though the chance of being shocked doing this is unlikely, they should ensure they are not doing so when a shock is delivered. Like the hovering of the hand, the knees do not have to be far away from the patient.

@thoughtfulcritter3099

5 жыл бұрын

@@autparamedicine7644 I see. I guess I'm just a bit concerned that people may get too comfortable being that close to the Pt that they might forget to clear by the knees and get shocked on accident. I know that this is more for the advanced crews, but it clearing the Pt should still be emphasized because it only takes one time for someone to get hurt, even if the odds are unlikely.

@ReyJoshuaEvangelio

2 жыл бұрын

@@thoughtfulcritter3099 Yah, same here. There is an importance to clear everyone from the patient before giving a shock for the responders' safety.

@samcherylarmstrong2943

2 жыл бұрын

There are now EMS agencies compressing through shocks. It's not lighting, it's bi-phasic shock. From one electrode to the other, I haven't seen anyone with an electrical exit would from defibrillation yet. I teach SHOCK, TAP, GO! The compressor counts 30 compressions from the time the AED reports shockable rhythm (Yes the next thing it says is "Do not touch the patient". The American Heart Association's Advanced Cardiac Life Support (ACLS) written test has had a question for the past 15 years that asked: Can you do CPR compressions while an AED is charging? The answer is YES. When the compressor reaches a count of 15 (Out loud of course - Counting is for coordination) the person running the AED puts a finger on the SHOCK button. The machine is alarming and the SHOCK button light is blinking. It's saying "DO IT! SHOCK ALREADY!", but bring the perfusion pressure up first, then at 30 the compressor pauses and hovers. The person running the AED has their right hand finger on the SHOCK button and left hand 6 inches (15 cm) above where the compressor will hover, They aren't watching the button anymore, they are watching the compressor's hands to make sure they're clear. 28, 29, 30, - Hover, Shock, Tap the compressor's hand with the hand 6" above the hovering hands, GO! Compressions resume. Your heart doesn't stop. This person on the ground is already having a cardiac event, let's not make it worse by delaying perfusion/circulation. Give them every possible chance. That means keep their perfusion levels as close to yours as possible. Let's not even start on ventilations....That person works for the compressor, it ain't a partnership.

They seemed to be touching the patient with their knees while they were administering the shock. Perhaps too close? Otherwise a great video.

@autparamedicine7644

5 жыл бұрын

Some people will need to be right up against the patient in order to position their shoulders over the centre of the patient's chest. Even though the chance of being shocked doing this is unlikely, they should ensure they are not doing so when a shock is delivered. Like the hovering of the hand, the knees do not have to be far away from the patient.

@samcherylarmstrong2943

2 жыл бұрын

There are now EMS agencies compressing through shocks. It's not lighting, it's bi-phasic shock. From one electrode to the other, I haven't seen anyone with an electrical exit would from defibrillation yet.