I understand that there is some 'footage' of this phenomena available; I'm
told as an MPEG. It shows progressive RV dilatation and decreasing LV volume
demonstrated on echo after cardiac arrest. Does anyone know where this can
be found?

Kind regards

Adrian Kerner

----- Original Message -----
From: "Paul Ransom" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, January 17, 2005 9:34 AM
Subject: Re: Limiting Shocks


> Mike,
>
> An interesting development in aiding ROSC in VF out of hospital
> arrests......
> Our local Ambulance Trust  ( Sussex ) are practising / trialling 100
> chest compressions before the first shock in cases of VF ?   This is
> part of a trial over the past months under the auspices of Professor
> Chamberlain.  The reasoning behind it seems to be that during VF the
> left ventricle is gradually emptying,  so that when a shock is
> administered,  there is effectively no blood for the ventricle to eject.
> The 100 chest compressions before shocking aims to refill and 'optimize'
> the left ventricle,  and apparently leads to more frequent and
> successful ROSC. (  Convincing work on dogs in Sweden,  anyway. )
>
> From a purely practical point of view, Mike,  the most discriminating
> question we would ask you IS in fact 'how long has the patient been down
> ?' The longer I practise,  the more it seems to me that the skill of
> managing 97% of out-of-hospital arrests lies in the kindness with which
> you can ensure that the team desists as early as possible.
>
>
> Paul Ransom
>
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Michael Bjarkoy
> Sent: 16 January 2005 23:49
> To: [log in to unmask]
> Subject: Re: Limiting Shocks
>
>
> Hi Simon
>
> Much of your post I agree with and a few weeks back tried very poorly to
> champion the cause for better ALS education, skills and drugs. I was
> shot down in flames so wont go down that line again.
>
> I would argue that unless we go back to the days of dumping patient onto
> stretchers and providing minimal prehospital treatment - the times from
> collapse to A&E arrival is often in excess of 30 minutes. The outlook
> for non perfusing patients in these circumstances is grim.
>
> I realise A&E appreciate the difficulties in the field and that is why I
> intimated that they continue resus sometimes for our benefit as well as
> normal resus policy.
>
> This compassion toward ambulance crews is appreciated a lot. But there
> is a feeling sometimes of 'oh, why did they bother bringing in this
> asystolic
> patient- what a waste of time' and I have heard often within a couple of
> minutes of arrival - 'OK 30 minutes down, I think that is long enough
> lets call it'.
>
> It is for this reason I believe it is better to get a pulse back on
> these patients before the load and go. 3 loops is an OK guidance, but I
> wouldn't want it to be set in stone. It is in some services! If a policy
> such as 3 loops - load and go is written into local ambulance policy,
> fingers wag and managers get very intimidatory when you don't go by the
> recommendations.
>
> I prefer to treat a treatable rhythm on scene unless I believe the A&E
> dept can offer better care. Sometimes I run, sometimes I stay and play
> and sometimes I call it on scene.
>
> Those who do best are usually those who get a ROSC - I am yet to be
> convinced otherwise.
>
> Mike
>
>
> ----- Original Message -----
> From: "Simon Horne" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Sunday, January 16, 2005 9:42 PM
> Subject: Re: Limiting Shocks
>
>
>> Not sure I necessarily agree with the desire to achieve ROSC first.
>> While good ALS en route must be very difficult (and believe me we in
>> A&E do appreciate this), we have access to more diagnostic and
>> treatment options than you do.  The half hearted attempt is more often
>
>> limited by the reality of an unsurvivable blood gas pH/lactate/base
>> excess combined with the knowledge that if an underperfused heart is
>> going to come back, it does so early rather than 35 minutes on.
>>
>> The opposite side of this coin is that when (as we had last week) the
>> arrest is secondary to a potassium of 7.8, this needs to be picked up
>> on in order to be successfully treated.  Your (and my) guidelines do
>> not include as standard the use of calcium gluconate or insulin for
>> every arrested heart but do involve the correction of metabolic
>> problems IF DETECTED.  While these are few and far between, you will
>> not achieve ROSC on scene in these or similar patients and indeed by
>> delaying transfer you may prevent us achieving it too.  Arguably any
>> return we get is likely to be brief in the majority, but that's
>> another issue.
>>
>> I think the three cycles on scene guide is as good a compromise as is
>> likely.  If recently in VF, or with a rapidly corrected hypoxia, you
>> will get results on scene.  If you don't get them soon though, then it
>
>> may be possible to achieve more if you just cut and run.
>>
>> Si Horne
>>
>>
>> -----Original Message-----
>> From: Accident and Emergency Academic List
>> [mailto:[log in to unmask]]On Behalf Of Michael Bjarkoy
>> Sent: 16 January 2005 17:15
>> To: [log in to unmask]
>> Subject: Re: Limiting Shocks
>>
>>
>> Hi Dave
>> No limitation on this in Devon, Somerset and Cornwall as yet. However
>> this is a dynamic profession we work in so next week it may all
>> change!
>>
>> I would imagine the limitation is the paramedics perception of what
>> can be achieved with the drugs s/he has.
>>
>> If you only have 6 Epi's and your running time to hospital is 9
>> minutes (for arguments sake) then you will probably perform 9 or so
>> minutes on scene
>> (3xEpis) resus, transfer to ambulance and then the perform another 9
>> minutes resus en route to A&E (the other 3 Epi's).
>>
>> This may be the 'logic' which may limit on scene times - I do not
>> necessarily hold this view. I would prefer to get the patient back
>> into ROSC first and then transfer.
>>
>> I really dislike working hard on a patient and transferring to A&E
>> before ROSC to be greeted with '... and how long has this patient been
>
>> down?' - the A&E team make a half hearted (excuse the pun) attempt at
>> further resus just
>> to make the paramedics (who is collapsed in the corner sweating
> profusely)
>> feel better for all his/her hard work.
>>
>> No, I prefer to get the patient back on scene, so the A&E team have a
>> viable patient to work on.
>>
>> happy New Year Dave
>>
>> Mike
>>
>> ----- Original Message -----
>> From: "dave.j.fletcher" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Sunday, January 16, 2005 9:15 AM
>> Subject: Limiting Shocks
>>
>>
>>> Are the list aware of any local ambulance service limitations to the
>>> number defibrillator shocks that crews can make before they must
>>> 'run' to hospital?
>>> Regards
>>> Dave Fletcher
>>>
>>>
>>>
>>
>>
>>
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