Monthly Archives: January 2013

Posted in Roy on Rescue • RoyOnRescue Personal Responses • CPR for Providers

Question: Why Dont We Check ABC’s Anymore?

Comments:1 Comment

In this blog,

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I answer a question that came in about why we don’t teach lay rescuers to check for pulses after AED shock. This student thought that we were trying to trick them but in reality, the new standards are what may be tricky. Here’s my answer, I hope it helps.

Hi Shelley,

Thank you for taking the time to comment about the training. I’m writing In regards to your question about AED use and then checking for “signs of life” vs checking for Airway, Breathing and Circulation. Id like to assure you that as wrong as it may seem to do CPR without checking for pulses first, the training you received from ProFirstAid.comis based upon the latest guidelines set forth by the American Heart Association and are correct.

The old standards were to shock with AED Training and then assess for Airway, Breathing and Circulation, if no pulse give CPR. The new standards have eliminated pulse checks for lay rescuers in order to simplify and hopefully reduce pulse check “mistakes”. This is designed to shorten time from arrival of help to first chest compression.

Now, if your feeling a little confused, don’t feel bad… many of us do when there are changes. Be assured that most people who are unconscious, not breathing normally and have received a shock are most probably in cardiac arrest and CPR is called for. Besides, studies show that chest compressions when not needed rarely ever cause severe harm. Better to error on the side if giving CPR.

This however, is the reason for change in training and per the AHA standards it is accurate.

I’d be happy to explain further and in more details if you like.

Best Wishes,

Roy Shaw, paramedic, instructor
ProTrainings.com

Posted in Roy on Rescue • Head Injuries

What Is Cerebral Venous Sinus Thrombosis?

Comments:

Hello Rescuers!

I received an email from a RoyOnRescue friend who had suffered a head injury while playing a sport.  After being seen by the doctor he was diagnosed with Cerebral Venous Sinus Thrombosis or (CVST).  He had asked me if I would give my explanation of what it is and if it was something he should be worried about.  His doctor had exCSVTplained it but he was still a bit foggy regarding the diagnosis.  Well, after looking into it from the clinical perspective, I realized that it was a pretty big deal and in some cases may be fatal.  I researched multiple sources to gather credible information and when it all came down to brass tacks, I found that the Wikipedia explanation had done a pretty dog-gone good job of summarizing CSVT.  So, with all credit given to them for most of this article and a link back to their website, here it is.

I have personally responded and treated many different types of head injuries as a paramedic but had not researched this problem to this level.  Then, shortly after receiving this question, I read that  Secretary of State, Hillary Clinton was diagnosed and hospitalized with the very same problem secondary to her head injury!  Ironic.   So, I thought to myself, if two people experienced this problem secondary to a common traumatic head injury(concussion), there may be more with the same question.

Here’s my trimmed-down version of what it is, what it’s symptoms are, how to determine if it is truly CSVT and then what a person may want to do if they think they may be suffering from such a complication.  So let’s dig into some of the questions you may have!  P.S.  You’ll notice there are more links then usual in this article.  The topic is so complex and has so many different facets I thought it wise to allow you to do some of your own information mining and hope the links make it easier.

Q:  What is a cerebral venous sinus thrombosis anyway?

A:  A CVST is the presence of thrombosis (a blood clot) in the dural venous sinuses, which drain blood from the brain. 

Q:  What causes a CVST?

A:  There can be many causes of CVST.  Here is a few I included:

Q:  How might I know if I have a CVST?

A: Headache that may worsen over the period of several days, but may also develop suddenly.  Strangely the headache may be the only symptom of cerebral venous sinus thrombosis.  Stroke, 40% of all patients have seizures, Common symptoms in the elderly with this condition are otherwise unexplained changes in mental status and a depressed level of consciousness.  The pressure around the brain may rise, causing papilledema (swelling of the optic disc) which may be experienced as visual problems.  In severely raised intracranial pressure, the level of consciousness is decreased, the blood pressure rises, the heart rate falls.  This is a common symptom found in closed head injuries which makes sense as the mechanism is very similar.

Q:  How will the doctor know if this is what I have?

A:  The most commonly used tests are computed tomography (CT) and magnetic resonance imaging (MRI), both using various types of radiocontrast to perform a venogram and  visualise the veins around the brain

Q:  How is a CVST treated and cured?

A: Treatment is with anticoagulants (medication that suppresses blood clotting), and rarely thrombolysis (enzymatic destruction of the blood clot). Given that there is usually an underlying cause for the disease, tests may be performed to look for these. The disease may be complicated by raised intracranial pressure, which may warrant surgical intervention such as the placement of a shunt.

AmbulanceQ:  Can this be serious?

A:  Yes.  Like any illness or injury that causes a problem with the circulation of oxygenated blood to our tissues, this type of problem can be very dangerous if left untreated.  It also runs a risk of complication in that it raises the intracranial pressures which can act similar to a closed head injury and this too can cause severe injury or death.  If a person has any of the symptoms listed above, they should be seen as soon as possible to rule out this potentially life threatening disorder.  If a person is reacting with decreased level of consciousness, or any type of life threatening complications, activation of Emergency Medical Services or 911 should be immediate with life saving or time buying intervention given.

 

I hope this helps and keep well!

See Source:

http://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosis

http://neurology.jwatch.org/cgi/content/full/2007/515/2

http://www.medscape.com/viewarticle/705510_3

 

 

Posted in Roy on Rescue • CPR for Instructors • CPR for Providers

Question Answered Regarding Aggresive Chest Compressions and Unconscious Choking Patient

Comments:

Screenshot-2013-12-04-14.22A really good question came in regarding the choking unconscious protocol.  The question was basically this.

Q:  The way the objective is taught regarding choking patients, you progress to chest compressions once the person loses consciousness with or without a pulse.  I can understand that and have taught that to my staff BUT those with ACLS certification quickly point out that ACLS still stresses that you do not do chest compressions in a patient with a pulse.  I am reviewing my ACLS and I can see the confusion.  As I see it, the key is in what you have available to you and in an unconscious choking vs respiratory arrest but I would like to better explain it and to do that I need to make my peace with it too.

Lastly,  In response to your training question regarding choking unconscious patient.  I know it’s hard to understand some of the changes that take place from time to time with the ILCOR and AHA recommendations.

A:  I’ll try and make sense of this particular skill.  Once we asses for unconsciousness or lower the unconscious choking patient down to the floor, and after calling 911, we’re going to begin 30 chest compressions immediately and then open the airway, check for obstruction or object in mouth and sweep it out if we see it.

If we don’t see it, we will attempt two breaths, if breaths don’t go in, we will reposition the head tilt and chin lift and try two more breaths(ideally with a one way valve mask in place).  If breaths do not go in, we will give 30 more chest compressions and then check mouth for object. Repeat until object is clear, airway is open or help arrives and takes over.  If at some point, we sweep an object  out and the breath goes in, we then check for a carotid pulse for no more than 10 seconds, if no pulse and no normal breathing…begin CPR.   If there is a pulse but patient is not spontaneously breathing, begin rescue breathing at 1 breath every five seconds.

Explanation:  The immediate chest compressions are due to a philosophy that the patient was already choking while conscious and instead of assuming that it came out after unconsciousness, we assume that it’s still blocking the airway.  The only thing we need to do if not already done, is activate the EMS or 911 system.  Then after 30 chest compressions, we check for produced obstruction.

Remember, even in ACLS, we are now less concerned about pulses and more concerned about time from non circulating heart activity or arrest to time of first compression. In other words, if we are not able to detect pulses or are unsure, but the patient is unresponsive and not breathing “normally” (agonal) the science and research is promoting aggressive cardiac compressions and minimization of time between arrest and first compression from CPR.  In this scenario, if the choking patient is in cardiac arrest, then they will benefit from  receiving 30 chest compressions before we check the airway.

Therefore, in theory, we’ve potentially circulated some residual oxygen to the brain and other vascular organs.  If the patient is not in cardiac arrest but simply still choking, the compressions should assist in relieving the obstruction and studies have shown that injury due to non-needed compressions is minimal.  This is why the emphasis on aggressive chest compressions.

I hope this helps anyone else who may have had the same question!