Stopping CPR w/ V-fib?

[Clare]

Regardless of the rhythm I don't believe in transporting cardiac arrests unless there is an exceptional circumstance where the hospital can potentially reverse the cause such as cardiac tamponade, electrolyte imbalance, advanced pregnancy or hypothermia. If the patient does not get a pulse back then the resuscitation is terminated and they are declared life extinct on the scene.

I also do not believe in commencing resuscitation unless it is in the best interest of the patient; for example traumatic cardiac arrest, patients who have a very poor health related quality of life (e.g end stage cancer or kidney failure) or asystole as presenting rhythm where the arrest was not witnessed and there is significant discretion available in this area.

 

[NomadicMedic]

I also do not believe in commencing resuscitation unless it is in the best interest of the patient; for example traumatic cardiac arrest, patients who have a very poor health related quality of life (e.g end stage cancer or kidney failure) or asystole as presenting rhythm where the arrest was not witnessed and there is significant discretion available in this area.

Do you not feel the resuscitation should occur, but you do it anyway... or are you given the leeway to not resuscitate those patients that you feel may have a "very poor health related quality of life"?

 

[Clare]

Do you not feel the resuscitation should occur, but you do it anyway... or are you given the leeway to not resuscitate those patients that you feel may have a "very poor health related quality of life"?

The idea goes something like Joe Blow rings up and says I have found so and so not conscious and not breathing which is now (as far as ProQA figures) a cardiac arrest until proven otherwise and will be resuscitated unless there is a very good reason not to; for example (as I said above) unwitnessed arrest with asystole, obviously dead or unworkable, traumatic cardiac arrest that doesn't get a very quick return of ROSC (5 minutes or so), patients who are dying from end-stage chronic diseases or have some other cause for a very poor HRQOL such as being in a vegetable state, needs somebody to walk/talk/shower/pee/poo/eat for them etc and also includes patients who have an advanced directive/allow natural death wishes including clearly described verbal wishes.

All decisions rest solely with the ambulance crew; while the wishes of the family must be considered they do not have the authority to demand resuscitation or infact any treatment or transport that is not (to the crew) clinically indicated.

The only time I would work a cardiac arrest that would not otherwise be worked is if it is in a very public place and even then it would have to be a non-traumatic arrest and would only probably be two rounds of CPR and defibrillation before pronouncing life extinct.

 

[NomadicMedic]

I want to work there!

 

[Clare]

I want to work there!

Working a cardiac arrest with the name Clare brings a whole new dimension to "everybody clear, shocking now!"

I guess you sort of turn round and go "what?" the first couple of times somebody says "clear!"