I'll agree with you on that, Lynne, but this was obvious artifact, not fine Vfib. The doc agreed with me when he put his glasses on. 
New ACLS????
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ArcticDiver
Contributor
I asked the question about Manual vs. Automatic Defibrilation because the machines will do it either way. One philosophy I've heard expressed is that since in a Code you are really only looking for some pretty clear rhythms that the machine can probably do just as good a job detecting why not let the machine to it? It would certainly help with the task loading.l
Are the people upon whom AEDs are used getting the short end of the stick? Or, are people making mistakes when doing manual defibrillation that could be avoided by using he machine? Is there any analytical information out there to support either belief?
Of course none of this goes to the heart of the question: "Should I attempt rescusitation?" The answer to that is a matter of local protocol and personal beliefs. Opinions about that make an interesting but hardly fruitful discussion.
Are the people upon whom AEDs are used getting the short end of the stick? Or, are people making mistakes when doing manual defibrillation that could be avoided by using he machine? Is there any analytical information out there to support either belief?
Of course none of this goes to the heart of the question: "Should I attempt rescusitation?" The answer to that is a matter of local protocol and personal beliefs. Opinions about that make an interesting but hardly fruitful discussion.
erparamedic
Vampire Girl......er Dork
catherine96821:
Actually, there is no problem with wet boats or saline. Like Arctic Diver mentioned before me... it is important that the skin be dry if you are using pads. If you are using paddles, then one must use the "gel pads" or gel, to prevent burns. I have shocked patients on wet surfaces as well as icy surfaces with no problems... and with pads and paddles. I like the pads the best... as it makes me "hands free" when shocking and I don't have to worry about applying ~ 25 lbs of pressure to the paddles as was recommended by the "old" defib that I used to use.
Another point to remember is to be sure that chest hair doesn't create an issue. We always have a razor available to shave chest hair. This is rarely a problem but there have been a 2 or 3 times that I can remember that I had to shave the patient before applying the pads... can we say, Furry!
ArcticDiver:
I don't think studies have been done. Like I said, I think it's just a matter of not wanting to let a machine make the decision. Besides, AEDs "move" slower than real people in codes. I've never used an AED, but I teach AED use and it takes a really long time to move through it's steps. I'd rather be looking at rhythms and pushing buttons. The waiting would be more stressful.
Wildcard:
If you feel so strongly about not following the new ACLS guidelines, then so be it. But, I find it troubling that you are so outspoken about falsifying a patient's record.
They are guidelines, sometimes we must waver from these guidelines in the best intrest of the pt. If I convert to a viable rythem with a pulse and pressure,Im NOT going to do compressions on top of it. No one questions statements like Dfib comverted to ST with strong radial pulses.... Im not going to say I refuse to do compressions on top of that. I just wont do it. Not falsified in any way. BTW welcome to the board, nice way to jump in.
Wildcard:
I am well aware that they are guidelines and I agree that the best interest of the patient is what should be kept in mind. What bothers me, as I said before, is your attitude towards the patient record - specifically your statement, "My paperwork may say otherwise."
Not exactly 'new' to the board - I just don't post much. But, thanks for the welcome. Oh, FYI, the correct spelling is r-h-y-t-h-m.
This has been an interesting thread, especially as we are still transitioning between 2000 and 2005 guidelines (I haven't formally updated) so we tend to perform a bit of a mixture.
As to the idea about whether AEDs are better, I would say no - I can evaluate a rhythm in less time than it takes an AED to tell me to apply the pads. I think AEDs are good for general public use, but if you have the skills...
As an aside, something to occurred to me recently is the effect that we as A&E/ER/ED staff might have on our pre-hospital colleagues. Our local crews do not have protocols to discontinue resuscitation, and I always feel a little bad when they come in, sweating from a lot of very hard work performing CPR in the rig, we hook up a monitor, get the down-time, do one cycle and go - OK call it.
I know it is the right decision, but I do feel bad for the crew.
Just my rambling 2c
As to the idea about whether AEDs are better, I would say no - I can evaluate a rhythm in less time than it takes an AED to tell me to apply the pads. I think AEDs are good for general public use, but if you have the skills...
As an aside, something to occurred to me recently is the effect that we as A&E/ER/ED staff might have on our pre-hospital colleagues. Our local crews do not have protocols to discontinue resuscitation, and I always feel a little bad when they come in, sweating from a lot of very hard work performing CPR in the rig, we hook up a monitor, get the down-time, do one cycle and go - OK call it.
I know it is the right decision, but I do feel bad for the crew.
Just my rambling 2c
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