NASCAR CPR
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1. The document discusses the importance of various steps in cardiopulmonary resuscitation (CPR), listing chest compressions, defibrillation, delivering breaths, and intravenous (IV) medications as the key elements. 2. It notes that defibrillation should have no more than a 10% delay after 6 minutes of oxygen, and that chest compressions result in 80% of cardiac output during CPR. 3. The document emphasizes that chest compressions should be the first priority in CPR, followed by defibrillation and ventilations, with IV medications as the last priority.
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NASCAR CPR
- 1. Luke Winkelman NRP, EMS-I, ACLS-I
- 3. A better way
- 4. 6 10 80
- 5. 6 Minutes of O2 10 80
- 6. 6 Minutes of O2 10% delay of Defib 80
- 7. 6 Minutes of O2 10% delay of Defib 80% CCF
- 8. 0 Bonus
- 11. 1. Chest Compressions What’s important?
- 12. 1. Chest Compressions 2. Defibrillation What’s important?
- 13. 1. Chest Compressions 2. Defibrillation 3. Delivering breaths What’s important?
- 14. 1. Chest Compressions 2. Defibrillation 3. Delivering breaths 4. IO & Meds What’s important?
- 16. Help!! 1. Compressions 2. Defibrillator 3. Ventilations 4. IO & Meds
- 17. Help!! 1. Compressions 3. Ventilations 2. Defibrillator 4. IO & Meds
- 18. Help!! 1. Compressions 3. Ventilations 4. IO & Meds 2. Defibrillator
- 19. Team leader
- 20. Your turn!
Editor's Notes
- Good news: I expect my lecture to only take 15-20 minutes Bad news: The exam at the end 40 so pay attention Get this show on the road~~~ZOOM~~~ Picture in your mind your last cardiac arrest How did it go? What went wrong? What have you done since then to fix those? Did it look something like this?
- Do you think it could have gone smoother? Was there a lot of wasted energy? Was there a lot of shouting? Would you have cringed if you had watched a video of it?
- It doesn’t have to be crazy or chaotic Everyone knows what the next step is, there’s no confusion There are a few important tasks to be performed, the rest is just frosting
- By the end of this hour I want 3 numbers to change how you perform CPR
- Is the number of minutes of unused oxygen present the moment the heart stops beating First observed in porcine models 97’ Prompted AHA to endorse hands only in 05’ Dec 15’ in NEJM MCT just under 27k arrests confirmed this. CARES data in Arizona also reflected a 3% increase in survival when a NRB was used instead of giving breaths http://circ.ahajournals.org/content/117/16/2162.full http://blog.heart.org/cpr-with-rescue-breaths-as-good-as-possibly-better-than-compression-only-cpr/ http://www.nejm.org/doi/full/10.1056/NEJMoa1509139
- Is the decrease per minute in survivability at 30 days when defibrillation is delayed for a shockable rhythm 17 different studies reviewed by the AHA helped identify that statistic http://circ.ahajournals.org/content/102/suppl_1/I-60.full
- 11’ MCT 2k patients found significant increase in probability of survival if CCF was greater than 80% only 14% included in that trial actually achieved it. 2011 Maine began working arrests on scene 300% increase in survival The only thing that benefits from transport is the budget http://bangordailynews.com/2012/07/16/health/emts-treating-more-cardiac-arrest-patients-on-scene/ http://www.ems1.com/ambulances-emergency-vehicles/articles/1375101-Maine-medics-triple-cardiac-arrest-survival-rate/ http://bangordailynews.com/2012/11/27/news/portland/portland-paramedics-skip-the-ambulance-rides-save-three-times-as-many-lives/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215827/ http://www.jems.com/articles/2010/11/science-cpr.html
- Dec 15’ Annals EM “no drugs have yet been shown to improve long-term survival from cardiac arrest” http://www.sciencedirect.com/science/article/pii/S0196064415014742
- 2011 Maine began working arrests on scene 300% increase in survival http://bangordailynews.com/2012/07/16/health/emts-treating-more-cardiac-arrest-patients-on-scene/ http://www.ems1.com/ambulances-emergency-vehicles/articles/1375101-Maine-medics-triple-cardiac-arrest-survival-rate/ http://bangordailynews.com/2012/11/27/news/portland/portland-paramedics-skip-the-ambulance-rides-save-three-times-as-many-lives/
- Most important part here is to get more help
- Can only do compressions for about 15 minutes before help is needed
- Who needs to be team leader? Not who wants to Pre assigned roles are ok, but does the team really arrive at the same time? Team leader assigns/reminds each arriving member of their role The team leader should not shout, still be the loudest voice in the room
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