Interesting findings but not really surprising. I especially appreciate the comment that treating the symptom; being cardiac arrest is the last event in the whole series of health related issues which lead up to it
I agree too that making AEDs widely available and training rescuers in what is now called "high quality CPR" is essential to survival. Speaking of, I wonder why we ever gravitated away from "high quality CPR" anyway.
Way back in the seventies, you had to generate a perfect strip from "Recorder Annie" in order to be certified. The compressions had to be within the acceptable depth box and delivered in the alotted time and the rescue breaths had to be of an acceptable volume. This brings me to the point of needing to comment on the current thinking that ventilations aren't considered equally important to compressions. Doesn't the second letter of the acronym stand for pulmonary? We're only talking about a minute or two for the lactic acidosis and hypoxemia to become critical. In this setting, all the catecholamine drugs in the world won't be of any value and anoxic brain syndrome is nothing to survive with anyway.
This rationale of logic in medicine bothers me. Is it really necessary to teach that if you can only do one thing correctly, then do this? I had no trouble learning quality breathing along with quality compressions. Is the AHA of the mindset that the public is now too stupid to wrap their heads around the concept that you have to both breathe and circulate for the arrested patient? Maybe I'm too optimistic but it seems to me that if we re-emphasized ventilations and continued the AED campaign, outcomes may improve
In summary, because of the current thinking, high quality CPR has the highest probability of being successful when you have an arrest witnessed by someone trained in the use of the AED AND, you have a shockable dysrhythmia.
A mightly tight criteria to fit into.
R
I agree, Ricu! If we are not oxygenating the patients, but only providing for circulation, then what are we circulating???
I also agree about the quality of compressions. In May, since I was not employed, I went to the local community college to renew my CPR. I do not mean to discriminate by age, but there was a 70-something retired nurse in my class who was so frail she could barely get on the ground to do the compressions on the mannequin. Lets just say her compressions were far from effective, but she passed..... :rolleyes:
Over the years, I have seen certification change from 2 years, to 1 year, and back to 2 years. RIGHT after last cert, they were talking do straight compressions. What next?
I'd say not too much, Amanda, right? Cat, I think that would be bag 'em but, not with the resuscitator...
R
I hate to rain on any parades, but.....was doing some thinking about many of my old patients, and some conversations with the various families. Things all boiled down to: we all are gonna die at some time, and all the 'medical breakthroughs' are just prolonging the inevitable. I know that sounds a bit cold, however: Pres. Kennedy's son Patrick would now survive Hyaline Membrane disease, etc.
I have done CPR on someone who already had suffered an MI 3-4 months prior to 2nd attack (did not survive this one). Yes, I look at quality of life, but not everyone sees things the same way. Don't know what to think about the study. 'Do' the AED's really make a difference?
suebird wrote:I hate to rain on any parades, but.....was doing some thinking about many of my old patients, and some conversations with the various families. Things all boiled down to: we all are gonna die at some time, and all the 'medical breakthroughs' are just prolonging the inevitable. I know that sounds a bit cold, however: Pres. Kennedy's son Patrick would now survive Hyaline Membrane disease, etc.
I have done CPR on someone who already had suffered an MI 3-4 months prior to 2nd attack (did not survive this one). Yes, I look at quality of life, but not everyone sees things the same way. Don't know what to think about the study. 'Do' the AED's really make a difference?
Hi Sue,
I couldn't agree with you more. Very few cardiac arrest victims survive and if they do, it's not for very long. The thing that gripes me is teaching rescue practices that just seem futile- concentrate on compressions but don't worry about breaths; if you can do it, fine but okay if you can't. What a waste...
I think AEDs will save many more lives than CPR alone will and those lives will likely have better quality. The quicker you restore a (spontaneous) perfusing rhythm, the shorter and consequently less destructive interruption there will be in the rest of the patients vital functions, especially neurological.
R
Then you have to think about patients that have made their wishes known (no cpr, no extraordinary measures at all).
Can't tell you how many times I've had family members turn around and tell us to "do everything" totally ignoring the living will on the chart.
Sometimes you can't win as a patient.
Andrew Lopez, RN
http://www.4nursing.comVery true, Andrew. I often wonder just how many ghosts will haunt me.
R
If I were a family member who went against the persons' wishes, THEN I would worry about ghosties.
Maybe we, as patients, should put that in our wills: If any family member goes against end of life wishes, etc., that person is automatically outta the will. No contest at all.
cougarnurse wrote:
[B]Maybe we, as patients, should put that in our wills: If any family member goes against end of life wishes, etc., that person is automatically outta the will. No contest at all.
Not a bad idea, it might make people think twice about going against a patient request.
Andrew Lopez, RN
http://www.4nursing.com