Comments on: A Question…

By: Jim Isbell

Jim Isbell — Wed, 07 Apr 2010 01:40:52 +0000

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.

By: Amanda

Amanda — Sat, 27 Mar 2010 08:03:52 +0000

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.

By: Greg Friese

Greg Friese — Fri, 19 Mar 2010 17:21:49 +0000

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.

By: Firefighter/Paramedic

Firefighter/Paramedic — Fri, 19 Mar 2010 16:29:14 +0000

You got me on that one.

By: mdc708

mdc708 — Fri, 19 Mar 2010 11:35:03 +0000

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!

By: Dan C.

Dan C. — Fri, 19 Mar 2010 06:13:21 +0000

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…

By: Epijunky

Epijunky — Fri, 19 Mar 2010 02:48:56 +0000

Hey Girly!!!

I get that part. Why do we do it then? That’s what I’m stuck on.

By: Karen

Karen — Fri, 19 Mar 2010 02:38:57 +0000

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.