Refresher Training: The ResQ Trial in Whatcom County. Prepared by Janice Lapsansky January 2008. Topics. Adult CPR. 1. ResQ Trial Refresher. 2. Click on this icon to reveal the answers to test preview questions . Learning Objectives.
ResQ Trial Refresher
Click on this icon to reveal the answers to test preview questions
This is an online EMS continuing education module for EMS providers in Whatcom County. After completing this course you will be able to:
ACD-CPR – active compression-decompression cardiopulmonary resuscitation
AED – automated external defibrillator
cardiac arrest – abnormal heart activity insufficient to produce a pulse
chest decompression – chest expansion as a result of natural recoil or ResQ Pump use
compression to ventilation ratio – alternating sets of 30 chest compressions and 2 ventilations during adult CPR with an unsecured airway (BVM ventilations)
DNR – do not resuscitate
ETCO2 – carbon dioxide content of air measured at the end of exhalation
impedence threshold device (ITD) – valve that prevents air from entering lungs during the decompression phase of CPR; aka ResQ POD
inclusion/exclusion criteria – decision list to determine whether a victim of cardiac arrest meets the qualifications to be enrolled in the ResQ Trial
secure airway – a cuffed airway, such as provided by an endotracheal (ET) tube or Combi-tube, and held in place by a tube holder
study randomization – pre-determined schedule of CPR method, strictly followed by controlling the availability of study devices on rescue vehicles
Cardiac arrest not witnessed by EMS:
When should the defib pads be applied to the patient?
Highlights of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Currents in Emergency Cardiovascular Care. Vol. 16 No. 4, Winter, 2005-2006
What will you do immediately after the first shock is delivered?
Because each rescue breath is given more quickly, will you also give a larger volume of air with each breath?
Should you pause chest compressions
to deliver breaths after tube placement?
How often should rescuers practice their CPR skills?
Your participation in the trial will provide critical information about EMS-provided CPR for adult victims of cardiac arrest.
The ResQ Trial will analyze:
What does AHA say is the most important factor in overall patient outcome following cardiac arrest?
“Allowing complete chest recoil after each compression allows blood to return to the heart
Highlights of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Currents in Emergency Cardiovascular Care. Vol. 16 No. 4, Winter, 2005-2006
Where can you find the phone number for the ResQ Trial hotline?
Known or presumed < 18 years
Obvious or likely traumatic etiology
Penetrating or blunt trauma
Pre-existing DNR orders
Obvious signs of clinical death (DOA)
Family members who request exclusion
For ACD-CPR+ITD arm: recent sternotomy (wound not appearing completely healed or, if known, < 6 months)
If the patient meets ANY of the exclusion criteria, perform Standard CPR.
Two-Person Rescue Breathing with a BVM
Maintain a tight, two-handed facemask seal.
When it’s time to pause compressions to give breaths, the person doing chest compressions should reach over and squeeze the ventilation bag.
ACD-CPR + ITD—Facemask Only
When should the ResQPOD’s lights be used?
ACD-CPR + ITD—Advanced Airway
Compress continuously @ 80/min (metronome)
Do not pause for breaths
Compress to 1.5 – 2” with active decompression (use gauge)
Move ResQPOD to airway and turn on timing assist lights
Ventilate according to lights or 8-10 breaths/min
What should you do if the patient’s pulse returns?
ResQPOD Fills With Fluid
ResQPOD Fills With Fluid, cont\'d
How long should CPR be performed on a patient with an unwitnessed cardiac arrest before analyzing with the AED?
When using the ResQPump, how hard should a
rescuer pull up (decompress the chest)?
Troubleshooting ACD-CPR, cont\'d
Give both CPR methods the greatest opportunity to work…
Do the best CPR possible!
This is slower than for rescue breathing alone.
“Push hard and push fast”
No stacked shocks
No pulse check after shock
Do not interrupt CPR for rhythm analysis or defibrillation for long periods of time. During these “no flow times” the brain and heart are not receiving oxygen in the blood. Prolonged no flow times decrease the chance that defib will work!
Immediate chest compressions of good quality will supply blood to the heart muscle that will help it respond better to medications and AED shocks
Deliver each breath over 1 second, with visible chest rise.
DO NOT increase volume!
DO NOT pause chest compressions to deliver breaths after tube placement.
Assure that the chest wall recoils completely after each compression in order to maximize the formation of the vacuum that promotes filling of the heart.
Good CPR takes training AND practice
One of the most important factors in overall patient outcome is the quality of CPR. The AHA recently revised their ACLS course, stating that “high-quality CPR is more effective than any ACLS drug. The science tells us that our focus should be on BLS skills to maintain perfusion.”
Currents in Emergency Cardiovascular Care. Vol. 17 No. 4, Winter, 2006-2007
Compress the chest 1 ½ - 2”
(65-90 lbs on strain gauge)
Blood Flow to Vital Organs During Chest Compressions
Interruption in chest compressions
Forward blood flow is accomplished beginning with 15 chest compressions, and sustained until compressions are paused for ventilations.
You can find the hotline phone number in:
Call the hotline after every cardiac arrest (including peds, trauma victims, & DOAs).
Research Hotline: 1-866-640-2832
ResQPOD with an ET Tube
The timing-assist lights should be turned on to guide ventilation rate (or 8-10 breaths/min.) only after an advanced airway is placed.
The ResQPOD enhances circulation.
When pulse returns…
The ResQPOD is a CPR tool
Keep the ResQ POD nearby in case the patient re-arrests.
YES! This is approximately 100 compressions per minute.
OR…you can hum the “Staying Alive” song