Question: Two questions which seem simple but as an educator I get asked all the time. 1.) FBAO VSA patient, you are unable to clear the airway, should we follow the BLS that indicates an oral airway should be inserted? 2.) Unwitnessed VSA, do we need to do a full two minutes of CPR or just CPR until we get the pads on.

 Thanks for the questions. We are assuming that your patient is not a DNR as this has been asked previously on multiple occasions. To answer your first question, yes, you should follow the BLS manual for a FBAO VSA patient as detailed in section 2-9 "Airway Obstruction-General Standard". A link to the BLS manual can be found here: http://www.health.gov.on.ca/english/public/program/ehs/edu/pdf/bls_patient.pdf

That being said, it should be noted that the specific mention of the use of the OPA in this standard relates to the Trauma section of obstructed airway (Section B). The "Known Foreign Body" (Section A) directs the paramedic to follow the HSFO Guidelines. Given however that in Section B, following the direction for paramedics to insert an OPA, they then direct the paramedics to follow the HSFO guidelines, we feel that this is appropriate to insert an OPA as listed.

To answer your second question, in unwitnessed cardiac arrest, paramedics should not perform a full two minutes of CPR. "Early vs Late" CPR methodology and "Priming the pump" concepts have been investigated by multiple large trials and the resultant 2010 American Heart Association Guideline state (Link et al Part 6: Electrical Therapies):

"When an out of hospital cardiac arrest is not witnessed by EMS personnel, EMS may initiate CPR while checking the ECG rhythm and preparing for defibrillation. There is insufficient evidence to determine if 1 ½ to 3 minutes of CPR should be provided prior to defibrillation. CPR should be performed while a defibrillator is being readied (Class 1, LOE B)"

Ironically, by the time you initiate CPR and your partner attaches the defib and applies the pads, often this translates to approximately 2 minutes. Adding another 2 minutes could result in a delay to defibrillation.

A link to the Guidelines can be found here: http://circ.ahajournals.org/content/122/18_suppl_3/S706.full

Cardiac/Circulation,Foreign Body Airway Obstruction,Medical Cardiac Arrest,Miscellaneous

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