MedicCast – Running Cardiac Arrests

Tuesday night (Tuesday, July 10, 2007) at 10:00 P.M. EST Jamie Davis will be hosting MedicCast Live an internet call-in show “Running the Code: CPR oversight and team leadership” discussing managing cardiac arrests and other difficult calls.

MedicCast

MedicCast Live

Visit Talkshoe.com to register for free and get a pin number to login.

Talkshoe.com

The show runs for an hour.

If you miss it, you can download the show later.

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Jamie asked me for my thoughts on the topic, so here they are:

One of the most satisfying aspects of the paramedic job is directing a code when you do it well. A well-run cardiac arrest is like a finely choreographed ballet. And then there are the codes from hell, which we will save for another day.

When I first started as a medic I had a tendency to focus right in on my skills — getting the tube, in particular, while losing sight of the big picture — directing CPR (When I said stop CPR, I didn’t mean stop it forever), getting the history (Oh, the patient’s a DNR. Sorry), mapping out an extrication route(What do you mean, you can’t move the refrigerator) among the many tasks needed.

I have always worked in a single medic system where you have to not only direct, but also perform all the skills. It took me quite awhile to feel fairly competent running a code. In the early years we rarely even had first responders.

I used to feel worthless in the first minutes of a code (after the initial placing on the monitor) because while everyone else was working on the patient, I would be getting out my airway kit, unzipping it, taking out the scope and blade, an ET tube, a stylet, a 10 cc syringe, unzipping another compartment to take out an ET holder, opening up the tube holder, placing it around the patient’s neck, putting the stylet in the ET tube, attaching the syringe, snapping the blade onto the scope, and then finally after what seemed an inordinate amount of time, announcing I was ready to tube. Then if I got the tube, I’d have to get out my IV kit and do the whole set up again, and climb over to the arm and put in an IV, and then climb back to where my med bag was, all the while glancing at the monitor and then having to reach over people to hit the shock button if necessary.

Now, if first responders are already on scene, I observe their CPR and ventilating while I attach my monitor and listen to the history. If I am first on scene, I attach the monitor and then get out the ambu bag and see how well the patient ventilates with just the bag mask. I’ll pass off the CPR and bagging to others, but only after making certain it is being done well.

One of the key things I have learned over the years is to position the monitor so it is close to me — not just within reach, but close enough I can see the difference between asystole and fine v-fib (years ago I could see this distinction across the room, now I need it closer). That can be difficult from across the patient. One medic I know taught me years ago to go for an EJ first. That way you can sit at the patient’s head and control of the airway, have the monitor sitting to one side in easy reach and have IV access right in front of you so you can run your meds.

Capnography has made codes much easier to run. You have ready verification of your tube, you can assess the quality of CPR, and you can spot return of spontaneous circulation or loss of it.

Capnography for Paramedics

Changing protocols have also made it easier with the cessation of resuscitation becoming more common so we often don’t have to worry about the extrication part unless we revive the patient.

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Try to check out the show. It should be an interesting listen as well as a chance to participate.

MedicCast Live

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