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Post Info TOPIC: Question of the Week (NEJM)
The best action is? [4 vote(s)]

1. Perform a blind finger sweep
0.0%
2. Wait for the AED to reanalyze the rhythm
50.0%
3.Continue rescue breathing without chest compressions
0.0%
4. Check for a pulse;
0.0%
5. Resume cardiopulmonary resuscitation for 2 minutes
50.0%
6. Run around the room screaming in terror?
0.0%
ed11563


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Question of the Week (NEJM)
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I hope none of us ever have to face this situation, but it does happen, and knowing what to do can make a huge difference in the outcome.

 --------------------------------------------------------------------------------------------------------------------------------------------

Question of the Week

For April 7, 2015

A 17-year-old female basketball player with no known medical history collapses on the court during a game. She is found to be unconscious and unresponsive, is not breathing, and lacks a pulse.

Cardiopulmonary resuscitation is initiated. When an automated external defibrillator (AED) is applied, it recommends a shock.

After the AED shock is discharged, which one of the following next steps is most appropriate?

Perform a blind finger sweep to ensure that no foreign bodies are obstructing the airway

Wait for the AED to reanalyze the rhythm, and deliver a total of three stacked shocks if indicated

Continue rescue breathing without chest compressions until the AED reanalyzes the rhythm

Check for a pulse; if none is present, resume cardiopulmonary resuscitation

Resume cardiopulmonary resuscitation for 2 minutes, and reanalyze the heart rhythm

- See more at: http://knowledgeplus.nejm.org/question-of-week/3012/?source=NEJMeTOC#sthash.bQY6vj47.dpuf

 

 

 

Choose:

1. Perform a blind finger sweep to ensure that no foreign bodies are obstructing the airway

2. Wait for the AED to reanalyze the rhythm, and deliver a total of three stacked shocks if indicated

3.Continue rescue breathing without chest compressions until the AED reanalyzes the rhythm

4. Check for a pulse; if none is present, resume cardiopulmonary resuscitation

5. Resume cardiopulmonary resuscitation for 2 minutes, and reanalyze the heart rhythm

Key Learning Point View Case Presentation

In a witnessed, out-of-hospital cardiac arrest during a sporting event, the most appropriate action after an automated external defibrillator provides a shock is to resume cardiopulmonary resuscitation.

Detailed Feedback

According to American Heart Association (AHA) guidelines, the two most critical factors in maximizing neurologically intact survival after cardiac arrest are fast, effective cardiopulmonary resuscitation (CPR) and early defibrillation. The most common underlying arrhythmia in out-of-hospital cardiac arrest is ventricular fibrillation.

When cardiac arrest is identified, it is of the utmost importance to activate emergency medical services, start CPR, and operate an automated external defibrillator (AED). If the cardiac arrest is witnessed, CPR should be started, and then an AED should be used as soon as it is available. If there is more than one rescuer, compressions should continue while the AED pads are placed on the patient.

Current guidelines recommend only one shock rather than three stacked shocks (one shock from a biphasic defibrillator is superior to three stacked shocks from a monophasic defibrillator). Then, 2 minutes of CPR should be given before reanalyzing the rhythm or checking the patient’s pulse. Rescue breathing should always be accompanied by chest compressions during the resuscitation period.

After a shock is delivered and 2 minutes of CPR have been administered, the rhythm should be reanalyzed with the AED before checking the patient’s pulse. Studies have shown that both laypeople and health care providers take too long to check for a pulse, thereby delaying CPR and defibrillation. Individuals should spend no more than 10 seconds checking for a pulse. If no pulse is palpated after 10 seconds, CPR should be resumed.

The AHA no longer recommends blind finger sweeping under any circumstances, as this may push foreign objects into the airway and cause an obstruction.

Citations

Link MS et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010 Oct 22; 122:S706.

American Red Cross. Step Three: Be Informed. Cardiac Arrest/AED Steps. 2007. https://www.redcross.org/flash/brr/English-html/AED.asp

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- See more at: http://knowledgeplus.nejm.org/question-of-week/3012/answer/E/#sthash.kYd2bhQS.dpuf

 

 

 



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Southern_Belle


Nothing's Impossible

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Puffing air into someone's lungs is useless if their heart isn't circulating blood to carry oxygen to the organs.

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ed11563


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Southern_Belle wrote:

Puffing air into someone's lungs is useless if their heart isn't circulating blood to carry oxygen to the organs.

Yes. Unless something newer came out, the latest instructions I've heard are to forget about the breathing, because the oxygen already in the lungs will be fine for a while, and continue chest compressions at about 100 times per minute until help arrives. 

 

Have to see how many people vote for choice #6, run around screaming ...



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lilyofcourse


My spirit animal is a pink flamingo.

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Move her and finish the game?

I kid, I kid.

The AED things were not around when I learned CPR. My guess would be check for pulse and continue CPR until the paramedics get there.



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Southern_Belle


Nothing's Impossible

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Once you hook up the AED you follow the instructions. It will shock. Reanalyze and tell you it wants to shock again or for you to resume compressions.

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Lawyerlady


On the bright side...... Christmas is coming! (Mod)

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If a 17 year old drops related to an unknown heart problem, you can do everything, but it is not likely to work. She would have an undetected heart defect that likely could have struck at any time. This happened to a friend's sister when I was in college. And she wasn't playing any sports - she was making breakfast.

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jlbear71


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Southern_Belle wrote:

Once you hook up the AED you follow the instructions. It will shock. Reanalyze and tell you it wants to shock again or for you to resume compressions.

 This.  Or at least, according to my AED training, this is what you are supposed to do.



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Empyreal


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Lawyerlady wrote:

If a 17 year old drops related to an unknown heart problem, you can do everything, but it is not likely to work. She would have an undetected heart defect that likely could have struck at any time. This happened to a friend's sister when I was in college. And she wasn't playing any sports - she was making breakfast.

 So sad. 

I know of 2 boys that died this way.  One was 15, he passed away in his shower at home. He was the brother of a school mate. They learned from the autopsy that it was a heart defect he had his whole life. 

Second one, 13, doing laps in gym class.  Collapsed and died. My husband works with his father.   I don't know specific details in each case, but same type of situation.  Heart defect since birth. 

Makes me want to get my kids hearts checked.  How else would you know?  Could it have been fixed? 

Scary stuff! 



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ed11563


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Hmm. No one voted for "run around screaming" yet. cry



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NAOW


Vette's SS

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I voted for #2 but I just took my CPR class a few months ago so it's fresh.

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