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The New CCR

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The New CCR

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    1. The New CCR Cardiocerebral Resuscitation Revised for Shorewood Hills EMS February 7, 2008

    2. Dr. Gordon Ewy from Tucson Arizona superimposed over Uncle SamDr. Gordon Ewy from Tucson Arizona superimposed over Uncle Sam

    3. Statistically represents the likelihood of someone surviving cardiac arrest.Statistically represents the likelihood of someone surviving cardiac arrest.

    4. This data indicates why CPR is important before defibrillation if the patient has been down for a while without adequate CPR.This data indicates why CPR is important before defibrillation if the patient has been down for a while without adequate CPR.

    5. Chest compressions extend the circulatory phaseChest compressions extend the circulatory phase

    6. Data indicates how survival rates actually decreased when AEDs became more prevalent in the 1990s.Data indicates how survival rates actually decreased when AEDs became more prevalent in the 1990s.

    7. ROSC = Return of Spontaneous Circulation The slide should read “ROSC Correlated to CCR”ROSC = Return of Spontaneous Circulation The slide should read “ROSC Correlated to CCR”

    8. Cardio-cerebral Resuscitation (CCR) is also known as Continuous Chest Compression CPR (CCC-CPR) Continuous Compressions are necessary to increase coronary perfusion pressures which increases return of spontaneous circulation (see previous slide)Cardio-cerebral Resuscitation (CCR) is also known as Continuous Chest Compression CPR (CCC-CPR) Continuous Compressions are necessary to increase coronary perfusion pressures which increases return of spontaneous circulation (see previous slide)

    9. Proper chest compression technique is important. Complete chest recoil is critical.Proper chest compression technique is important. Complete chest recoil is critical.

    10. The last bullet should really read “Rescuers are unaware of the importance of chest compressions (CC)The last bullet should really read “Rescuers are unaware of the importance of chest compressions (CC)

    11. Indicates the importance of only pausing Chest Compressions for a very short timeIndicates the importance of only pausing Chest Compressions for a very short time

    12. This slide indicates that artificial ventilations are detrimental to coronary circulation. We WILL need to ventilation later in the protocol.This slide indicates that artificial ventilations are detrimental to coronary circulation. We WILL need to ventilation later in the protocol.

    13. Data indicates survival rates of 44.2% in this CCR studyData indicates survival rates of 44.2% in this CCR study

    14. Tucson Arizona studyTucson Arizona study

    15. More promising study dataMore promising study data

    16. More data from Kansas City studyMore data from Kansas City study

    17. Wisconsin dataWisconsin data

    18. The studies appear to dramatically increase survivalThe studies appear to dramatically increase survival

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    22. Apparently in some instances implementation has been difficult. They have only been able to get about 50% compliance from their EMTs.Apparently in some instances implementation has been difficult. They have only been able to get about 50% compliance from their EMTs.

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    24. ACLS vs. CCRACLS vs. CCR

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    29. Survivability appears to significantly decrease at about three to four minutesSurvivability appears to significantly decrease at about three to four minutes

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    33. Consider adducting the patient’s arm perpendicular to the body to assist Paramedics when they arrive on scene.Consider adducting the patient’s arm perpendicular to the body to assist Paramedics when they arrive on scene.

    34. Dr. Stiegler is working on a protocol for first responders and the general public related to AEDs and CCR. It would be a political disaster for EMS if we told everyone AEDs are “useless” after so many people put so much money into them.Dr. Stiegler is working on a protocol for first responders and the general public related to AEDs and CCR. It would be a political disaster for EMS if we told everyone AEDs are “useless” after so many people put so much money into them.

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    36. In the first four minutes place an oral airway and non-rebreather mask at 15 liters per minute. It will be important for EMTs and other responders to know how to change regulators on portable oxygen cylinders.In the first four minutes place an oral airway and non-rebreather mask at 15 liters per minute. It will be important for EMTs and other responders to know how to change regulators on portable oxygen cylinders.

    37. A moving ambulance = bad chest compressions (CC). A likely scenario will be either transporting a patient with a pulse or termination of resuscitation efforts in the field after paramedics have arrived and provided their treatments with no success.A moving ambulance = bad chest compressions (CC). A likely scenario will be either transporting a patient with a pulse or termination of resuscitation efforts in the field after paramedics have arrived and provided their treatments with no success.

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    44. “M” of McMAID = Metronome “c” of McMAID is sometimes written as “ccc” = Continuous Chest Compressions“M” of McMAID = Metronome “c” of McMAID is sometimes written as “ccc” = Continuous Chest Compressions

    45. 2nd “M” = Monitor2nd “M” = Monitor

    46. “A” = Airway“A” = Airway

    47. “I” = IV or Vascular Access“I” = IV or Vascular Access

    48. “D” = Drugs The IV and medications are beyond our scope of practice but with any PNB we will be getting Paramedics paged to the scene as well. It may be helpful if you, as a Basic EMT, have an idea of what the Paramedics will be doing when they “take over” care.“D” = Drugs The IV and medications are beyond our scope of practice but with any PNB we will be getting Paramedics paged to the scene as well. It may be helpful if you, as a Basic EMT, have an idea of what the Paramedics will be doing when they “take over” care.

    49. These are the skills in which we are going to practice and certify ALL of our EMTsThese are the skills in which we are going to practice and certify ALL of our EMTs

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    51. During a cycle of 200 compressions: Towards the end of the cycle (last 10-15 seconds) the Code Commander will charge the Defibrillator and be ready to evaluate the rhythm, shock and resume chest compressions.During a cycle of 200 compressions: Towards the end of the cycle (last 10-15 seconds) the Code Commander will charge the Defibrillator and be ready to evaluate the rhythm, shock and resume chest compressions.

    52. EMT Basic = Insert Combitube after 600 compressions (3 cycles of 200). We will be considering End Tidal CO2 (EtCO2) monitoring in the near future.EMT Basic = Insert Combitube after 600 compressions (3 cycles of 200). We will be considering End Tidal CO2 (EtCO2) monitoring in the near future.

    53. Recognize conditions of our Termination of Resuscitation in the Field protocol.Recognize conditions of our Termination of Resuscitation in the Field protocol.

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    56. Dr. Kellum recommends re-training every 3 months. We will be recertifying in this revised Advanced Skill every six months just like we did with the old Defib / Combitube protocol. Additional training will be provided as needed.Dr. Kellum recommends re-training every 3 months. We will be recertifying in this revised Advanced Skill every six months just like we did with the old Defib / Combitube protocol. Additional training will be provided as needed.

    57. Dr. Stiegler has high expectations for this program. He hopes the training is passed on to ALL Paramedics (done), ALL EMTs (doing), ALL Police Officer, Firefighter, First Responders (coming soon) and the lay public as well.Dr. Stiegler has high expectations for this program. He hopes the training is passed on to ALL Paramedics (done), ALL EMTs (doing), ALL Police Officer, Firefighter, First Responders (coming soon) and the lay public as well.

    58. Dr. Ewy (Tucson, AZ) and Dr. Kellum (Janesville, WI) were prominent in these studies.Dr. Ewy (Tucson, AZ) and Dr. Kellum (Janesville, WI) were prominent in these studies.

    59. Dr. Barney and Dr. Kellum provided this slide show. We have modified it for our training needs.Dr. Barney and Dr. Kellum provided this slide show. We have modified it for our training needs.

    60. The EndThe End

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