Pulse Check Decisions

Slides by Josiah Sitemeung, Alex Ryden, Brian Locke

Pulse Check Decisions

Code blue on E50

Compressions ongoing when you arrive.

You establish yourself as the code leader.

First Pulse Check

No palpable pulse

Rhythm strip during initial pulse check

What’s your next step?

What to do when you’re uncertain?

Coarse vs Fine Ventricular Fibrillation

Turn up the gain. Enroll help. “Are we certain this is asystole?”. If in doubt, shock.

Second Pulse Check

No palpable pulse

Second Pulse Check

Airway team ready to intubate, asks for a moment before resuming compressions

What is the big picture?

Only a few things really matter

  1. If they don’t have a pulse, someone is performing high quality compressions with NO significant breaks

    • Limit pauses (position changes, pulse checks, intubation, Lucas)

  2. Shock early when they have a shockable rhythm

Zoll Feedback mode

CPR resumed but can’t feel a pulse

How else can we detect ROSC?

  1. End Tidal CO2 (EtCO2)

  2. Doppler

  3. POCUS

  4. When in doubt, continue compressions

EtCO2 is underutilized

EtCO2

Use EtCO2 to help detect ROSC

Scenario: Third Pulse Check

ROSC

EtCO2 = 36 mmHg

Summary:

  • DO NOT MISS FINE V.Fib

  • Only allow, at most, a few seconds of CPR delay for intubation, Lucas, repositioning

  • Use EtCO2!

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