a couple if issues here,

perfect ALS for who? for the massive PE CA or the hypovolemic CA or hyperkalemic CA

SPECIFICITY, we supposedly demand it in studies
demand it in ourselves

protocols are sometimes crap, they are a rough guide

you can’t protocol everything in life

protocols are for the average patients but define the average patient ?

he/she does not exist

protocols are for McDonalds workers not skilled medical thinkers and at least mcdonalds workers make food

and when u don’t have time to think, skill steps up

second one is, the silly push for technology over humanity

if you cannot reliably trust yourself to feel a pulse, that’s your problem, to fix

Pulse taking reliability?

depends on how often one practises it

but to tell others what they can feel, whether they can feel a pulse

>is rubbish, in my opinion

here standards or expertise or clinical acumen come into play

generalisation like treating all CA the same is like the generalisation about pulse taking and reliability

stuff the ETCO2 it may add a bit but is not the be all and end all, nothing ever is

you want to assess ventilation and perfusion, well pt is blue,poor to no cap refill, poor or no pulses everywhere,
he’s in trouble
a child could tell

while one may reach for the ETCO2 for reassurance
i am looking to reviving the patient as reassurance

Systematically going through the fundamentals by LOOKING AT THE PATIENT

A obstruction -hypoxia
B leak -tension pneumo
C FEEL PULSE if poor?

leak? hypovolemia

block? vsl PE, etc etc etc
D
by this time u/s has arrived and can be used specifically to check contractility

look for reversible cardiac effusion

or dilated RV

and even some of these triggered by decent hx if you think

once you have made this assessment you can push u/s away because it can delay and get in the way if used inappropriately

or you may use it specifically to assist you in removal of pericardial fluid, if you can’t do it without

the more skill you have the less you need machines
but once you know your limits, you know were machines can be of use

and Never take a picture of a dying patient, Fix them

keep calm and fix problem early or now

The ultimate judges of our standards are our Patients