> Regarding the CPR training we were given: "if you're not breaking ribs, you're not pressing hard enough" (1/3rd chest depth). 'CPR' shown on TV shows and movies, 'rubber bendy arms', is woefully inadequate and I wonder how much of this is contributing to the mortality rate of cardiac events?
Paramedic and ex fire guy, absolutely. I used to tell the guys on my engine, "You're doing push ups on their chest, basically.". 1/3 to 1/2. It's hard to go too deep.
Don't even start me on that asystole tone and paddles being applied...
Treatable, to a point, yes. Essentially, if one of the reasons there's no electrical activity is that it's just "stalled out" due to a lack of fuel for cellular activity, then you can recover. But the window/opportunity is very small (and comes with the accompanying challenge that if the heart is being starved of fuel, the rest of the body is, including the brain).
Current research shows that the administration of epi has little to no effect on survivability, other than within the first six minutes of arrest (which I now want to read more on, because I wonder if there's any correlation with that and the approximately 7-8 minutes of oxygenation in the blood). And then of course there's the complication (for understanding epi in isolation) that if you're in a position to administer epi <6m from arrest, the patient is likely getting holistic CPR.
Epi is believed to help stimulate the return of a shockable rhythm in asystole. But increasingly, it starts to feel like "because we've always done it". (Random fire 'joke': Firefighters hate two things: change, and the way things are.)
I'm in the PNW, where we're not perfect, but generally have some of the highest cardiac arrest survival rates (here, and Rochester MN).
Very early and progressive EMS system, driven by people like Dr Copass (https://www.seattletimes.com/seattle-news/health/dr-michael-...) who helped pioneer a lot of what you'd see in EMS in the early 1970s, and came from a very strong focus in cardiac outcomes. Although that would be unfair to Medic One's cofounder, Dr Cobb (also mentioned in that article) - Copass was the director of emergency medicine at Harborview (Seattle's Level 1 Trauma Center) for 35 years, but had a background in neurology, and Dr Cobb was a cardiologist.
Throughout the PNW (or I'm talking specifically the Puget Sound region - Snohomish, King, Pierce and Thurston counties), that has lived on, with a huge emphasis in bystander CPR as well as heavy participation in research around arrest outcomes and survivability.
So, heavily cultural. Though not perfect (there's certainly areas of EMS in the PNW that can be not as progressive - my own county took far too long to change the scope for long backboard use, i.e. spinal immobilization, finding that there was no real evidence to support its use for that purpose, and often caused patient injury/pain/discomfort or poorer outcomes).
Paramedic and ex fire guy, absolutely. I used to tell the guys on my engine, "You're doing push ups on their chest, basically.". 1/3 to 1/2. It's hard to go too deep.
Don't even start me on that asystole tone and paddles being applied...