A Question…

One of the best things about blogging is the chance to get to know (and in some cases actually meet) other people with the same passions that I have.

99% of the time those folks have forgotten more about EMS and taking care of people in general than what I’ve learned in five years.  It’s humbling, but at the same time, I wouldn’t trade it for the world.  I mean, look at the opportunities I have to learn!

While in class the other day I updated my Facebook status (because I’m a geek like that) with a simple statement:  “PALS today.”

I got a few thumbs up and assorted positive comments.  And then one of those people I look up to posed a question.

“Be sure to ask your instructors to explain how a 16% ejection fraction at 100 compressions per minute is better than 80% ejection fraction at 60 beats per minute.  We literally induce mechanical V-fib on these kids doing CPR on profusing pulses, but follow all local guidelines. Don’t ever do the math.”

Hrm.

Please… Someone explain this to me.  And remember that I’m a student with a fragile mind.

As in, I can’t remember why I walked into the kitchen, or the name of my dog most days.

Educate a girl!

8 Comments

  • Karen says:

    I was looking at that the other day. The following is what I got from it. When a peds heart is beating 60 times a minute assuming it is fairly healthy it pumping with an 80 percent ejection fraction meaning it is pumping pretty well. PALS teaches that you do CPR at 100 compressions per minute if the ped is at 60. When you do CPR the ejection fraction is nowhere near the heart’s ability. So if you are overriding the hearts normal ability with a faster less effienct “beat” that is not really helpful to your patient. When you break it down it makes a little more sense. I had to think abtou it for awhile. This is what I took from it whether or not I am right no clue.

  • Dan C. says:

    I hope more experienced minds chime in, but here’s my $0.02. You are taught the less than 60 rule as a “catch all.” If you do happen to get a peds patient that bradycardic (heaven forbid) and they are circling the drain, if you remember nothing else, do CPR. Personally, if I had a kid that was hr<60, I'd refer to that great phrase "treat the patient." If they did indeed have an 80% Ejection Fraction, most likely they won't look as crappy as someone that is rapidly decompensating, so you might have some time to do other interventions like ensuring adequate airway and breathing. Hopefully things perk up and the kid doesn't need more than that in the way of resuscitation. Best policy is to get to the hospital before that happens… Can't wait to see what smarter people say, but thought I'd give it a shot…

  • mdc708 says:

    For the same reason that we do a LOT of things in EMS – because somebody thought it would be a good idea and doing something is better than doing nothing..

    EMS….years of tradition surviving dispite those pesky realities of science!

  • Greg Friese says:

    You might find some answers in the 2005 AHA ECC guidelines explanations http://circ.ahajournals.org/cgi/reprint/112/24_suppl/IV-167 and references cited.

  • Amanda says:

    Another thing to remember is that it is “pulse less than 60 with signs of poor perfusion.” So, one could expect that if you have a child with signs of poor perfusion, they probably are not enjoying all 80% of that ejection fraction, so compressions might actually improve the EF to something that will perfuse the child better.

  • Jim Isbell says:

    If the patient is showing effective signs of perfusion, why compress the chest? Also, how are you going to effectively measure ejection fractions? Keep in mind that PALS are guidelines, not protocols and certainly not Law; minimum standards of knowledge do not (and certainly SHOULD not) override commonsense.

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