Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD
Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.
Come to Resuscitation 2015 in Prague and become one of the first to learn about the science behind the guidelines from the authors of the 2015 Resuscitation Guidelines.
Put the algorithms into practice through state-of-the-art hands-on session. Network with the experts through tutorials, seminars and interactive session. Learn how to put the guidelines into practice through the new European Resuscitation Council courses.
All this plus the apportunity to show your skills through the annual European CPR competition, and share your work others through the oral and poster presentations.
Resuscitation 2015 promises to deliver an exciting update on all aspects of resuscitation science, guidelines and practice.
If you have a presentation, please use this slide as your last slide to advertise the congress.
Clinical Performance Improvement Officer at Chesapeake Fire Dept
Surviving a Cardiac Arrest is NOT "Automatic"; its Manual! Is a bit of play on words. There are many steps a healthcare provider can take to increase the likelihood of a patient surviving a Sudden Cardiac Arrest (SCA). The first is decrease the time off the chest around delivering a defibrillation. The time is referred to as peri-shock pause and the most efficient way to make this happen is to operate the defibrillator in "manual" mode. The human eye can recognize VF (Ventricular Fibrillation) in less than a second and if the monitor is pre-charged, we can quickly deliver the shock and go back to compression with minimal interruptions.
In almost all cases, it's best to stay on the scene to work a cardiac arrest resuscitation until the return of spontaneous circulation or efforts are stopped due to futility, according to Dr. Brent Myers, medical director of Wake County EMS System in Raleigh, N.C.
Patients with an increased time off of the chest around the defibrillation are far less likely to survive their SCA neurologically intact. [1] So make it manual if it's in your scope of practice.
Data has proven your chances of surviving a sudden cardiac arrest is 11x more likely if you live in one county/city vs. another. 55% versus 5%.
Stop Moving & Do Compressions! So often in the past we were taught definitive care was in an emergency department, as pre-hospital providers we shot for that goal and quickly moved the patient while attempting an ongoing resuscitation. How foolish is that logic. It is a rare case when the hospital can do more than EMS to correct a pulseless state. The key to have a patient survive neurologically intact is high quality CPR and every moment we put to packaging and moving we are not focused on high quality compressions and meeting critical benchmarks of resuscitation.
We absolutely need to attempt an active resuscitation where the patient presents in cardiac arrest, even if this is the ambulance bay of the emergency department. Every second counts, so make them count and do what is right. Furthermore because of the sheer number of cardiac arrest we manage we are far better at resuscitation than our hospital partners and we need to own this part of our patients care. To quote Dr. Brent Myers "resuscitation is a prehospital enterprise, post resuscitation care is a hospital enterprise".
Light them up every 2 minutes without interruption & switch compressors! It is important to stay on a cycle of checking pulses every 2 minutes and precharge the monitor prior to pause for a rhythm and pulse check. Our goal is to limit breaks in CPR to 10 second or less. By pre-charging the defibrillator we are less likely to have big breaks in CPR.
Changing compressors every 2 minutes has proven to increase the quality of CPR. Even a very healthy provider decreases by some degree after 2 minutes of compressions, especially when they focus on active recoil and not resting on the chest between compressions.
CPR analytics will open your eyes!If your service has tools or software that will provide feedback on the quality of you CPR, use it. I recently reviewed a cardiac arrest and the crew was sitting right at 50% compression ratio and their rates were 90-160/minute. After reviewing the data with the crew they orchestrated a resuscitation a few days later that was nearly flawless and with a 96% CPR ratio. They also decreased their peri-shock pauses by 30 seconds on average.
Measure ETCO2 to guide ROSC & TORP! End-tidal carbon dioxide monitoring is a must in any critically ill patient, especially ones experiencing a cardiac arrest. ETCO2 initially was used to confirm and monitor endotracheal tube placement. Over the last decade EMS has expanded its use and it has
become a valuable tool to guide our care in resuscitation. It should be placed on the patient as soon as possible even when maintaining a BLS airway. It can provide instant information about perfusion status, quality of compressions, Return of Spontaneous Circulation (ROSC), and even guide our decisions about Termination of Resuscitation Processes (TORP).
Santa Checks his list twice and so should you! For years the aviation industry has used the checklist to ensure critical steps are not missed. If list are good for pilots and Santa they are definitely good for healthcare providers that are making life or death decisions under very stressful situations. A checklist should not be a protocol in list form but a list of critical task that make a clear difference in patient's outcomes. At a minimum we should have one for an active resuscitation; post ROSC & TORP.
Data has proven your chances of surviving a sudden cardiac arrest is 11x more likely if you live in one county/city vs. another. 55% vs. 5%. There are many factors that go into making a system that fully embraces all the links in the "Chain of Survival" but I suggest we start with the low hanging fruit and do the things that are within our control and financial resources. The final thing is to make yourself a Resuscitation Champion for your system. By simply being aware of best practices, providers can adjust and improve things within their scope of practice. After you tighten up your game then profess the evidence to your leaders and fellow providers to drive the rest of the system.
Attempts to revive people who have stopped breathing date back centuries. But it was in the late 1950s and early 1960s that modern CPR developed.
By AMERICAN HEART ASSOCIATION NEWS
1740 - Paris Academy of Sciences recommends mouth-to-mouth resuscitation for drowning victims.
1891 - Dr. Friedrich Maass performs the first documented chest compressions on a patient.
1903 - Dr. George Crile reports the first successful use of external chest compressions to revive a patient.
1956 - Dr. James Elam and Dr. Peter Safar develop the modern technique of mouth-to-mouth resuscitation.
1958- Work begins on the Resusci Anne manikin, developed by toy company owner AsmundLaerdal, Dr. Peter Safar and Dr. Bjorn Lind. The training aid is introduced in 1960.
1960- Dr. James Jude (from left), Dr. William Kouwenhoven and G. Guy Knickerbocker publish a paper in the Journal of the American Medical Association on “closed-chest cardiac massage,” which evolved into cardiopulmonary resuscitation, or CPR.
1963 - The American Heart Association formally endorses CPR.
1966- The first CPR guidelines are published by the National Academy of Sciences–National Research Council.
1972 - The world’s first mass CPR training program begins in Seattle, certifying more than 100,000 people in the first two years.
1981 - 911 operators in King County, Washington, begin giving CPR instructions over the phone — a practice that is now recommended nationwide.
1983 - The AHA convenes a national conference to develop CPR guidelines for children and infants.
1990s - Public Access Defibrillation programs begin placing automated external defibrillators, or AEDs, in public places and provide training to the public.
2005 - The AHA develops the Family & Friends CPR Anytime Kit, allowing anyone to learn CPR in 20 minutes.
2008 - The AHA introduces Hands-Only CPR.
2015 - Through a network of about 400,000 instructors and 4,000 training centers worldwide, the AHA trains more than 17 million people in CPR each year.
Twenty-seven states now require hands-on, guidelines-based CPR training for high school graduation. Each year, more than 1.6 million public high school graduates will have been trained in CPR.
Sources: American Heart Association, Journal of the American Medical Association, Laerdal Medical
Cities nationwide should consider using mobile phones and apps to connect people in cardiac arrest with nearby CPR-trained rescuers, say new guidelines from the American Heart Association.
The guidelines, published Thursday in Circulation, claim that such community programs could increase bystander CPR, which, depending on the community, is performed in 10 percent to 65 percent of the roughly 326,000 cardiac arrests that happen outside the hospital each year.
Accessing people through a mobile network can get help to the scene faster, said Raina Merchant, M.D., director of the Social Media and Health Innovation Lab at Penn Medicine.
“While emergency system personnel are on their way, bystanders can come by and start helping out,” said Merchant, an assistant professor of emergency medicine at the University of Pennsylvania Perelman School of Medicine who was not involved in writing the new guidelines.
About 90 percent of American adults have cellphones and two out of three have smartphones, according to the Pew Research Center.
The new recommendation is largely based on a Swedish study that tested a mobile alert system in Stockholm. The study, published in June in The New England Journal of Medicine, found that bystander CPR was initiated in 62 percent of cardiac arrests among the group who received cellphone alerts. In the group that did not receive alerts, CPR was performed 48 percent of the time.
“There’s a lot of work that needs to be done about how to best optimize these programs,” said Merchant. “Simply having the program doesn’t ensure that people will use it.”
About 1,400 U.S. communities are implementing a CPR mobile alert program developed by the nonprofit PulsePoint Foundation, said president Richard Price. When a cardiac arrest happens, 911 dispatch centers alert responders within a quarter mile of the patient.
Potential responders register through a free mobile app, which alerts them when an emergency occurs, maps directions and reminds them how to give chest compressions. After the emergency, the system sends the local EMS agency a detailed report about the incident and surveys responders about their actions.
“By directly alerting those who are qualified and nearby, maybe in the business next door or on the floor above, PulsePoint is able to put the right people in the right place at the right time,” Price said.
Annual costs to implement the system range from $8,000 a year for communities with up to 300,000 residents to $28,000 a year for populations of 1.5 million or more, according to Price.
Communities already using the alert programs will aid in research about why people respond and how to get them to respond, said Merchant.
In addition to summoning rescuers, cellphones also allow people at the scene of a cardiac emergency to get CPR instructions from 911 dispatchers without leaving the victim’s side. Dispatchers should be trained to help callers recognize cardiac arrest quickly and walk them through chest compressions, the guidelines say.
The AHA recommends that anyone who sees a teenager or adult suddenly collapse call 911 and push hard and fast on the center of the chest, a technique known as Hands-Only CPR.
The AHA guidelines have been updated every five years through a complex process involving more than 250 international experts from the AHA and six other resuscitation councils that form the International Liaison Committee on Resuscitation.
At an AHA-hosted ILCOR conference in early 2015, seven expert panels discussed, debated and reached consensus on hundreds of resuscitation topics, based on research published since the 2010 guidelines.
The AHA used that scientific consensus to create the CPR and Emergency Cardiovascular Care guidelines: “how-to” manuals that translate the science into practice. They are used to train millions of potential rescuers and are integrated into state and local emergency medical services protocols.
“CPR saves lives. That’s the big take-home from the guidelines. A lot of the science that works continues to work,” said Merchant.
“We need more people to do CPR,” she said. “Some will be through mobile, some will be through dispatchers … some will be remembering from a training class. [Mobile] is one part of the solution, but not the only piece.”
Resuscitation 2014. 15-16-17 May 2014, Bilbao Spain The pathway to new Guidelines
Welcome to Resuscitation 2014!
This year's conference promises to be one of the most exciting to date. The conference will focus onthe pathway to new Guidelines.
Come and hear about the hottest controversies in resuscitation science, education and implementation, and gain an insight into how these controversies may be resolved to produce the new resuscitation Guidelines due for publication in 2015.
At the same time, why not try your hand at one or more of the advanced skillworkshops, or enter a team for the 2014 InternationalCPR Competition? Seize the opportunity to network with international experts and present your research to key opinion leaders.
