CPR Induced Consciousness – An Important Phenomenon to be Aware Of

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Author: Jake Toy, DO
Harbor UCLA Medical Center
Originally published: Common Sense July/August 2019

In a recent resuscitation of an unconscious elderly woman in ventricular fibrillation, my team observed that upon initiation of cardiopulmonary resuscitation (CPR), she began to make purposeful movements with her arms and legs. During compressions, she batted at the mechanical CPR device and reached for her endotracheal tube. When attempting to place a femoral line, she withdrew to pain from the needle on that side. Through these periods of seemingly purposeful movements, her eyes remained closed and she was not responsive to voice commands. Upon pulse checks, these movements abruptly ceased. Many questions arose during this resuscitation for my team: Should we physically restrain the patient? Should we chemically sedate? What was the level of the patient’s awareness?

Electrical Storm: Don’t Just “Push Another Milligram of Epi”

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Author: Khalid M Miri, OMSIV
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific

"Are you ready to call it?" "Not yet, let’s push one more of epi." Sound familiar? Despite doing proper CPR, defibrillating, and pushing all the ACLS meds, you know deep down that after the first few rounds of chest compressions, your cardiac arrest patient has a tiny chance of surviving to discharge in good neurological condition. You have seen too many codes that go on too long and all you know to do is keep pushing epinephrine and hope that your patient is that one rare case that will achieve sustained ROSC. Have you ever wished you had another option, something that might work when epinephrine and amiodarone do not? Well, an additional option may exist. During a specific condition — refractory ventricular fibrillation — research shows that using a beta blocker can have a better chance of bringing that patient out of their dysrhythmia than when using epinephrine and antidysrhythmics alone.

Cardiac electrical storm (ES) is often defined as three or more episodes of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) within 24 hours. It is a dangerous arrhythmia that leads to refractory VF and will kill most of its victims despite treatment with the current ACLS recommendations of epinephrine, antidysrhythmics, CPR, and defibrillation.[1]

Use of Mechanical CPR Devices has Increased 1,511% - What You Need to Know

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Author: Jake Toy, OMS II
Western University of Health Sciences
College of Osteopathic Medicine of the Pacific, Pomona, CA
AAEM/RSA Publications Committee Member

This post was peer reviewed.
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Introduction
There are an estimated 424,000 out of hospital cardiac arrests (OHCA) among Americans annually.[1] Survival rates for OHCA are low, ranging from 10.6% to 31.4%.[2] External defibrillation and CPR represent the first line treatments for OHCA. The American Heart Association (AHA) defines high-quality CPR as 100-120 compressions per minute (CPM) at a depth of 2 inches on the average adult. Allowance of full recoil, minimization of compression interruptions, and avoidance of excessive ventilation are also important (Figure 1).[3] 

Figure 1. 2015 American Heart Association Adult CPR Guidelines (Source – American Heart Association[2])

On the Horizon: Shock - Administered Uninterrupted Chest Compressions

Originally Published: Modern Resident, Dec/Jan 2013

Original Author: Meaghan Mercer, DO University of Nevada Las Vegas

Submitted by: Rachel Engle, DO; Joe Lex, MD MAAEM FAAEM, Temple University Hospital
 
It is important to revisit and challenge dogma in medicine. When you think of defibrillation you hear the word "CLEAR" and know your primary job in that one instant is to make sure that none of the medical professionals participating in that code situation are at risk of receiving a life threatening shock. However, with the advent of gel adhesive pads is it still dangerous?