Missing

She frequented a neighborhood park near the hospital. I’d see her times smoking a cigarette while she sat on the playground swings. Many nights, she slept on cardboard by the fence, sometimes she tied a tarp from the fence down to the grass to provide shelter on rainy nights. She was tall and gawky with […]

Pearl #10 Involve the Family

Involve the family. When I started it was common practice to shoo the family out of the room. Not just on the scene, but in the ED. I no longer do that. I make certain to explain to a family member or members what we are doing and how things are progressing. If they choose […]

Pearl #9 Don’t Be Prisoner to the Clock

Don’t be held prisoner to the clock. Stay and work the patient as long as believe you have a shot. There is nothing magic about twenty minutes. I have on several occisions shortly after the 20-minute limit was talked about, gone into another room or out to the ambulance to call medical control for permission […]

Pearl #8 Anticipate LOSC

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Anticipate LOSC (Loss of Spontaneous Circulation). Once you have pulses back with ROSC (Return of Spontaneous circulation) anticipate you will lose them and have your plan in place. Premix your epi or norepi-drip and have it ready to go. Don’t start moving the patient immediately after getting ROSC. I usually wait 5 minutes to get […]

Pearl #7 Use ETCO2 to Predict Arrest Cause

If two identical twins are standing next to each other at a family reunion, and one chokes on a sandwich leading to cardiac arrest, and the second suffers a simultaneous VF arrest, and two medics arrive exactly 5 minutes later, and both patients are intubated at the same time, will their ETC02 numbers be the […]

Pearl # 6 Use ETCO2 to ensure CPR Quality

ETCO2 measures cardiac output. The better the CPR, the higher the cardiac output.  The higher the cardiac output, the higher the ETCO2. While the American Heart Association  recommends you switch compressors every two minutes during a cardiac arrest to prevent compressor fatigue.  A fatigued compressor can’t maintain consistent CPR.  The compressor tires, the cardiac output […]

Pearl # 5: Preattach ETCO2 Filter to ET Tube

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When intubating preattach the ETCO2 to the tube.  If you have a narrow stylet, this is possible.  Attach the ETCO2 to the monitor.  If I have trouble seeing the chords, I hand the tube to my assistant, then using my right hand apply crick pressure until I can see the chords, then I have my […]

Pearl # 4: CPR Coach

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Make certain the CPR and airway management are being done properly. When I started our protocol said to intubate immediately.  On arrival, I would turn my back on the code and take the two minutes it takes to get my intubation roll out, unzip everything, take everything out, open the packages, assemble everything and then […]

PEARL # 3: Make space for your cardiac arrest.

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You can’t work an arrest if you don’t have space to do effective CPR. I often come into a bedroom where responders are trying to work a code, and I will flips beds up on their sides, clear out couches, or if the patient is wedged in the bathroom, haul them out into the hallway, […]

Pearl # 2 Precharge your Defibrillator

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Charge your defibrillator before looking at the rhythm. Whether you and your partner are the first person at the patient’s side or first responders or laypeople are already doing CPR on your arrival, initiate and/or keep CPR going while you apply your pads.  Then with CPR still continuing, charge the defibrillator.  Only then stop CPR […]

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