# 16 y/o mvc



## paccookie (Jun 22, 2013)

Your pt is a 16 y/o female who was ejected from a dune buggy. The dune buggy also landed on her, although you cannot tell exactly how. No seat belts were worn. Unknown speed. Vehicle went off the pavement and rolled into a ditch. Your pt was initially found prone in the ditch and rolled over by pd to be found pulse less and apneic. CPR was started although pd believed your pt to be doa. 

You and your partner arrive and immediately begin working and packaging your pt. obvious swelling noted to the cervical spine both anteriorly and posteriorly. Eyes are beginning to swell and appear raccoon like. Bleeding from the mouth and nose and right ear. No other immediate trauma noted. Pt has blood in her airway. 

You c-spine and move her to the truck via backboard. Partner looks for a line, firefighter takes over CPR and you start on the airway. You suction blood from the mouth and attempt to visualize the cords. You see a lot of blood and swelling. You can see a tiny piece of the epiglottis and attempt intubation. Ends up in the esophagus. You attempt to intubate the trachea around that tube without success. Your pt is beginning to have trismus and you are unable to visualize much of anything. Back to suctioning and then you attempt a king airway. Due to the trismus you try to hold her jaw open with the laryngoscope blade. King airway is not successful. More suctioning and ventilating with bvm. Lungs sound very full but you have chest rise and fall. 

Your partner has an IO established. Monitor shows asystole. CPR still going. Supervisor shows up and realizes you do not have a stable airway. Says you must go to community hospital that is about 4-5 miles or 6-7 minutes from scene. You would prefer to go to level one trauma center that is about 15 miles or 12-15 minutes away due to traumatic mechanism, obvious head and spinal injuries and pt being a pediatric pt. 

What do you do?


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## Akulahawk (Jun 22, 2013)

Patient is VSA, determine death on scene. Call Coroner/ME. If unable to determine death by protocol, needle cric, run like mad to nearest facility, allow them to pronounce... unless protocol absolutely dictates all peds go to level 1 facility.


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## Wheel (Jun 22, 2013)

DOA, for sure. Pulse less, apneic, asystole on the monitor is all we need to call it. The fact that it's a traumatic arrest solidifies it. I know some medics might work it for the sake of the family, but that's neither here nor there.


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## DesertMedic66 (Jun 22, 2013)

Patient is DOA. Traumatic arrest with asystole = DOA


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## Medic Tim (Jun 22, 2013)

The pt is dead. Pronounce and wait to be released by pd or coroner.


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## Handsome Robb (Jun 22, 2013)

*edit: ignore the 9 year old comments... Not sure how I turned 16 into 9 but I did....all it changes though is which surgical airway technique I'd use if we were working this...but I wouldn't so take it for what it's worth.*

Injury incompatible with life. 

Time of death is when I mark on scene and make pt contact. I'd be tempted to possibly call a doc at the TC just to cover my *** to get orders seeing as it is a pedi and all.

Sounds like a can't oxygenate, can't ventilate scenario so seeing as shes 9 years old she gets a needle crich if you're dead set on working/transporting her. Preferably with jet insufflation if you have it but if not a BVM will at least give you something to work with. Depending on the size of this 9 year old it may be worth discussing a surgical crich but I doubt any doc would approve that to a random medic calling them unless they knew you...and you had a viable patient.

Sounds like a call you ran recently. Doesn't sound fun, pedi arrests are awful and no matter what people tell you they don't get any easier.


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## Akulahawk (Jun 22, 2013)

Robb said:


> Injury incompatible with life.
> 
> Time of death is when I mark on scene and make pt contact. I'd be tempted to possibly call a doc at the TC just to cover my *** to get orders seeing as it is a pedi and all.
> 
> ...


The patient is 16... and no, those calls don't get easier.


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## Aidey (Jun 22, 2013)

Like everyone else said. DOA. Does not get worked. Does not get moved to the truck.

Edit: If for whatever reason you do transport, closest facility, no lights, no sirens. The pt is dead, and that is not going to change no matter what hospital you take them to.


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## Handsome Robb (Jun 22, 2013)

Akulahawk said:


> The patient is 16... and no, those calls don't get easier.



I have no idea where I got 9 from...sorry about that. Been a long week. Surgical crich it is then. Probably a touch smaller on the tube...5.0 or 5.5 rather than 6.

Only thing the age changes is the surgical airway technique I'd use...other than that it's the same.

I've had far too many pediatric arrests in my short career as a medic.


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## CritterNurse (Jun 22, 2013)

In my area, if there's no pulse, there's no transport. If a patient becomes pulse-less en route, we're supposed to pull over and try to get a pulse back if possible before continuing.


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## Handsome Robb (Jun 22, 2013)

CritterNurse said:


> In my area, if there's no pulse, there's no transport. If a patient becomes pulse-less en route, we're supposed to pull over and try to get a pulse back if possible before continuing.



So if they arrest em route and you can't get ROSC your supes don't have an issue with you being 10-7 while you wait for the coroner? 

I agree no pulse no transport. If you're already to that stage though just go to the hospital in my urban, 5-15 minute transport brain talking. Looks pretty bad to the general public if they call for help only to have the ambulance never make it to the hospital because they pulled over when the patient arrested en route and never got ROSC so they were pronounced in the box...

We're not supposed to transport code 3 with CPR in progress per our new QA/I director but its not an official written policy yet.


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## NomadicMedic (Jun 22, 2013)

DOA should mean no transport, but unfortunately emotions may get in the way, especially if you have a volunteer BLS that scoops up a DOA, starts working it and goes full tilt boogie toward the hospital and then requests a rendezvous with medics. You're committed at that point. :/

I would have left this one on scene.


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## CritterNurse (Jun 22, 2013)

Robb said:


> So if they arrest em route and you can't get ROSC your supes don't have an issue with you being 10-7 while you wait for the coroner?
> 
> I agree no pulse no transport. If you're already to that stage though just go to the hospital in my urban, 5-15 minute transport brain talking. Looks pretty bad to the general public if they call for help only to have the ambulance never make it to the hospital because they pulled over when the patient arrested en route and never got ROSC so they were pronounced in the box...
> 
> We're not supposed to transport code 3 with CPR in progress per our new QA/I director but its not an official written policy yet.



We're not a private company. One department I'm on is municipal, and the other is a non-profit all volunteer department. State law says no CPR in a moving vehicle, so we really don't have much of a choice there. Of course if we're within sight of the hospital we might continue, but otherwise, we're pulling over.

Also, at least one hospital has put out a notice to all departments stating that we are NOT to bring them dead bodies.


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## Akulahawk (Jun 22, 2013)

DEmedic said:


> DOA should mean no transport, but unfortunately emotions may get in the way, especially if you have a volunteer BLS that scoops up a DOA, starts working it and goes full tilt boogie toward the hospital and then requests a rendezvous with medics. You're committed at that point. :/
> 
> *I would have left this one on scene.*


As would have I. Things get even more _interesting_ when transport is also BLS... they may be required to transport because AED's often can't show a rhythm, nor can BLS often be expected to interpret a rhythm, so if the protocols say "rhythm < 40/min"... as criteria for a field determination of death, BLS is still stuck transporting. 

So, if you're committed to transport, go full-tilt-boogie to the closest facility unless protocol absolutely directs you to go elsewhere.


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## Handsome Robb (Jun 22, 2013)

CritterNurse said:


> We're not a private company. One department I'm on is municipal, and the other is a non-profit all volunteer department. State law says no CPR in a moving vehicle, so we really don't have much of a choice there. Of course if we're within sight of the hospital we might continue, but otherwise, we're pulling over.
> 
> Also, at least one hospital has put out a notice to all departments stating that we are NOT to bring them dead bodies.



Private, municipal or volunteer it doesn't matter... You're still taking the resource out of service...sometimes for a very long time. Unless you're allowed to divert to the coroner's office.

I bet that state law gets violated all the time. What state? Sorry I'm on my phone. 

Sorry I read my post and realized I came off ride. Wasn't intending to jump down your throat.


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## ZombieEMT (Jun 22, 2013)

*DOA or  Closest*

I generally agree with the consensus here that it should be pronounced on scene and left at a DOA. If transport does occur, cardiac arrest goes to closest facility regardless of what caused the arrest... Where I work, generally this decision is made by ALS. If ALS makes and assessment and reports we work the code, it goes closest. If DOA then we leave it DOA. The only time we make DOA on BLS end is if patient is an obvious.

I can also tell you, I have had the experience where our ALS provided will ride in a DOA of pediatric/teen for the family. I do not exactly agree with this, as we are just passing the buck to somebody else to hand down the bad news.


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## CritterNurse (Jun 22, 2013)

Robb said:


> Private, municipal or volunteer it doesn't matter... You're still taking the resource out of service...sometimes for a very long time. Unless you're allowed to divert to the coroner's office.
> 
> I bet that state law gets violated all the time. What state? Sorry I'm on my phone.
> 
> Sorry I read my post and realized I came off ride. Wasn't intending to jump down your throat.



I'm in Maine, and I think we're allowed to divert to a funeral home. I'll check with the chiefs next time I see them.


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## Akulahawk (Jun 22, 2013)

The last time I checked with the county that I last worked in, we could divert to a funeral home if the patient met all of the following: had a DNR and had previous arrangements made to go to a specific funeral home, and we were aware of those arrangements. Otherwise, we had specific protocols as to what we were to do with the decedent, which basically dependent upon where the decedent was at the time of death.


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## Darwin (Jun 23, 2013)

I'm going against the grain here but I would have worked the pt as the OP did...and to be honest, I don't see how/why some of the people that posted in this topic are in EMS.  We are here to HELP people, so do it, even if you think the outcome is poor, there still is a chance.  I really hope some of you don't work on my family.  They aren't dead until they are warm and dead.


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## Arovetli (Jun 23, 2013)

Darwin said:


> I'm going against the grain here but I would have worked the pt as the OP did...and to be honest, I don't see how/why some of the people that posted in this topic are in EMS.  We are here to HELP people, so do it, even if you think the outcome is poor, there still is a chance.  I really hope some of you don't work on my family.  They aren't dead until they are warm and dead.



Because they read books with science in them.

I cant help the victims fate. Working the arrest isn't going to bring her back. She doesn't need an ACLS book, she needed flash gordon as a trauma surgeon complete with a surgical suite to be standing in the trees where she ended up.

It truly is a sad event, but sometimes there really is nothing we can do. If you understand the physiology behind this arrest, there really is no saving them at this point. It is terribly unfortunate.


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## DesertMedic66 (Jun 23, 2013)

Arovetli said:


> Because they read books with science in them.
> 
> I cant help the victims fate. Working the arrest isn't going to bring her back. She doesn't need an ACLS book, she needed flash gordon as a trauma surgeon complete with a surgical suite to be standing in the trees where she ended up.
> 
> It truly is a sad event, but sometimes there really is nothing we can do. If you understand the physiology behind this arrest, there really is no saving them at this point. It is terribly unfortunate.



This. With a lot of traumatic arrests there is nothing that can be done to help/save them.


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## Darwin (Jun 23, 2013)

Arovetli said:


> Because they read books with science in them.
> 
> I cant help the victims fate. Working the arrest isn't going to bring her back. She doesn't need an ACLS book, she needed flash gordon as a trauma surgeon complete with a surgical suite to be standing in the trees where she ended up.
> 
> It truly is a sad event, but sometimes there really is nothing we can do. If you understand the physiology behind this arrest, there really is no saving them at this point. It is terribly unfortunate.



You are correct that the patient's prognosis is poor; however, it is not our place to play GOD and decide whether or not to work this child...According to the information in the original post, this patient still had a chance, minimal, yes, but still a chance...that child is someone's baby, and speaking as a parent, I would want to know that everything was done to try and save my child, regardless of how remote that chance was.  Having worked many code situations on children in the past 11 years, I am here to tell you that parents need to see that you have done everything possible for their baby, they don't want to hear the medical mumbo jumbo until they are at a point that they can accept that any further rescue efforts are futile.  That is their baby, not ours!  Let's not take the CARE out of healthcare...


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## Arovetli (Jun 23, 2013)

Darwin said:


> You are correct that the patient's prognosis is poor; however, it is not our place to play GOD and decide whether or not to work this child...According to the information in the original post, this patient still had a chance, minimal, yes, but still a chance...that child is someone's baby, and speaking as a parent, I would want to know that everything was done to try and save my child, regardless of how remote that chance was.  Having worked many code situations on children in the past 11 years, I am here to tell you that parents need to see that you have done everything possible for their baby, they don't want to hear the medical mumbo jumbo until they are at a point that they can accept that any further rescue efforts are futile.  That is their baby, not ours!  Let's not take the CARE out of healthcare...



I understand where you are coming from, but it is our place to perform, or on the few unfortunate occasions to withhold resuscitative measures if grounded in the basis of science. No one is playing God or weighing fates. It simply is. Terribly tragic yes, but it is.

I cant rebuild their torn cardiovascular system by crushing further on their chest.

We literally do not have a therapy for the circumstance the patient suffers from.

 As it is a emotional topic to you, I suppose we shall have to agree to disagree.


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## Tigger (Jun 23, 2013)

Blunt trauma arrests have a mortality rate of greater than 99%. Is that chance worth thousands of dollars in medical bills for the devastated family? How about risking your own life and that of the public to transport emergency, only to have the ED doc call it as soon as you walk in? Is it worth giving the family a false sense of hope too?


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## Aidey (Jun 23, 2013)

Darwin said:


> You are correct that the patient's prognosis is poor; however, it is not our place to play GOD and decide whether or not to work this child...According to the information in the original post, this patient still had a chance, minimal, yes, but still a chance...that child is someone's baby, and speaking as a parent, I would want to know that everything was done to try and save my child, regardless of how remote that chance was.  Having worked many code situations on children in the past 11 years, I am here to tell you that parents need to see that you have done everything possible for their baby, they don't want to hear the medical mumbo jumbo until they are at a point that they can accept that any further rescue efforts are futile.  That is their baby, not ours!  Let's not take the CARE out of healthcare...



This patient has one prognosis: Dead. We aren't playing god, we are providing appropriate care based on the patients presentation. This patient does not have a chance. She has very obvious injuries that incompatible with life. 

Studies have shown that families of patients of all ages are ok with us calling them on scene. Transporting actually results in worse family satisfaction scores (for lack of a better way to put it). They believe that everything that could be done was done, even without transport. I'll see if I can find the studies. Something like 96% of families prefer that we call on scene if there is nothing different the hospital can do. And this is definitely a case where no amount of modern medicine will fix anything.


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## Akulahawk (Jun 23, 2013)

Darwin said:


> I'm going against the grain here but I would have worked the pt as the OP did...and to be honest, I don't see how/why some of the people that posted in this topic are in EMS.  We are here to HELP people, so do it, even if you think the outcome is poor, there still is a chance.  I really hope some of you don't work on my family.  They aren't dead until they are warm and dead.


I suggest you take a course of study that will take you through a basic biomechanics course, because it'll give you an appreciation for understanding what happens to the body when certain forces act upon it. Only then should you take PHTLS, which by then should be very easy for you to comprehend. That's when you'll have that "lightbulb" moment about traumatic arrest. 

Some of us in this forum have very advanced training and education in this field. Primarily, those people are those of us that have physician – level, athletic trainer – level, physical therapist – level, or similar level training on top of being paramedics for other advanced prehospital provider above EMT.

I have met several people that are both athletic trainers and paramedics. Because of their education in sports medicine and paramedics, I think you would find that those people in particular would be extremely good at evaluating traumatic injury. They also know the forces involved, where to look for injury because of those forces, and also have a very good understanding of when it is not likely that someone would survive their injuries.

In my own educational background, I have received extensive experience dealing with collision, contact, and noncontact sport injuries. Most of my time has been spent dealing with football, wrestling, soccer, volleyball, baseball/softball, Track & Field, swimming, diving, and basketball. Although I have never worked a Rodeo, I feel very confident in my ability to manage injury sustained by the participants of that Rodeo. This is because the education that I have received over the years would allow me to properly identify and treat those injuries. I am also very well acquainted with the fact that some injuries are not survivable, even if I had a full trauma team on-site at the moment of injury and ready to go to perform life-saving surgery, even assuming that they knew exactly what the injury was going to be.

That is why when I read the scenario posted by the OP, I responded exactly the way I did. That is probably also very much the reason why other posters on this particular thread said the same thing. Now, it is completely obvious that most of the people here on this forum do not have the same level of training that I do. Some of the people in this forum have much greater training than I do. I would, at this point, wager that a fair number of people here have more recent experience than I do. When they say something, I generally listen and determine if it applies. You should too.


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## Darwin (Jun 23, 2013)

Arovetli said:


> I understand where you are coming from, but it is our place to perform, or on the few unfortunate occasions to withhold resuscitative measures if grounded in the basis of science. No one is playing God or weighing fates. It simply is. Terribly tragic yes, but it is.
> 
> I cant rebuild their torn cardiovascular system by crushing further on their chest.
> 
> ...



There is nothing to indicate the possibilities you mention, that would require diagnostics in the ER.  This is somewhat emotional but still based on information in the original post...see more below. 



Tigger said:


> Blunt trauma arrests have a mortality rate of greater than 99%. Is that chance worth thousands of dollars in medical bills for the devastated family? How about risking your own life and that of the public to transport emergency, only to have the ED doc call it as soon as you walk in? Is it worth giving the family a false sense of hope too?


99% is in adults, science also says that children recover from severe injuries that are fatal in a normal adult.  I think I can speak for most parents when I say that money is not a factor when it comes to my child.  And I would ask, what would be a case to risk everyones lives to transport emergent?  I can tell you for a fact that an ED doc will take extra steps to work a ped code.

As I mentioned peds have a better chance of recovery.  Another thought to ponder, the pt was found prone with swelling to the neck, there is a chance that the cardiac arrest was secondary to respiratory arrest due to swelling of the airway, which was my initial thought when reading the first post.  This is well known and documented.  But to my surprise a numerous amount of postings following, stating it should have been field pronounced.  To me, the age, the unknown cause of arrest, and lack of obvious signs of death should indicate work the code and transport.


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## DesertMedic66 (Jun 23, 2013)

Darwin said:


> There is nothing to indicate the possibilities you mention, that would require diagnostics in the ER.  This is somewhat emotional but still based on information in the original post...see more below.
> 
> 
> 99% is in adults, science also says that children recover from severe injuries that are fatal in a normal adult.  I think I can speak for most parents when I say that money is not a factor when it comes to my child.  And I would ask, what would be a case to risk everyones lives to transport emergent?  I can tell you for a fact that an ED doc will take extra steps to work a ped code.
> ...



Cause of arrest = blunt trauma arrest. 
Obvious signs of death = blunt arrest with asystole on the monitor. 

Some ER docs may try harder and other ER docs will call it as soon as you walk into the ER. 

How about instead of transporting this patient right away, contact the hospital and let the Dr make the call whether to transport or call it in the field?


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## Tigger (Jun 23, 2013)

Darwin said:


> There is nothing to indicate the possibilities you mention, that would require diagnostics in the ER.  This is somewhat emotional but still based on information in the original post...see more below.



Blunt trauma by way of the a several hundred pound vehicle to the chest is not going to just magically do no significant harm. Physics at work. If this is an emotional topic for you, how do you plan to work such a call? You cannot let emotions dictate your care, kids of your own or not.



> 99% is in adults, science also says that children recover from severe injuries that are fatal in a normal adult.  I think I can speak for most parents when I say that money is not a factor when it comes to my child.  And I would ask, what would be a case to risk everyones lives to transport emergent?  I can tell you for a fact that an ED doc will take extra steps to work a ped code.
> 
> As I mentioned peds have a better chance of recovery.  Another thought to ponder, the pt was found prone with swelling to the neck, there is a chance that the cardiac arrest was secondary to respiratory arrest due to swelling of the airway, which was my initial thought when reading the first post.  This is well known and documented.  But to my surprise a numerous amount of postings following, stating it should have been field pronounced.  To me, the age, the unknown cause of arrest, and lack of obvious signs of death should indicate work the code and transport.



Actually, the science is just as clear cut with pediatrics. Sure, many children are more likely to have a better prognosis from a serious injury. They do not however, have a better prognosis in recovering from death.

Look up the pediatric trauma scoring system. Score this patient. I came up with a conservative 0. The mortality rate for patients with a PTS score of less than or equal to 0 is 100%. This is published in BTLS literature. 

As for the more emotional points in your post, driving emergent is shown to markedly increase the risk of accident by up to 300%. I am not sure if you are saying that it would be worth risking others' lives for a this patient, I certainly hope not. The age should not have much to do with how this patient is treated. At 16 this patient has more in common with an adult than a child.


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## ffemt8978 (Jun 23, 2013)

DesertEMT66 said:


> Cause of arrest = blunt trauma arrest.
> Obvious signs of death = blunt arrest with asystole on the monitor.
> 
> Some ER docs may try harder and other ER docs will call it as soon as you walk into the ER.
> ...



That works


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## Darwin (Jun 23, 2013)

DesertEMT66 said:


> Cause of arrest = blunt trauma arrest.
> Obvious signs of death = blunt arrest with asystole on the monitor.



Cause of arrest:  you are 100% sure based on the information given?  You have no doubt at all that it was not airway compromise?

Obvious signs of death:  can you show me where this is listed in any protocol?

I do agree with you about the possibility of consulting with medical direction while still on scene.  I would be curious what a doc would say if they recv'd a call with this infomation.


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## DesertMedic66 (Jun 23, 2013)

Darwin said:


> Cause of arrest:  you are 100% sure based on the information given?  You have no doubt at all that it was not airway compromise?
> 
> Obvious signs of death:  can you show me where this is listed in any protocol?
> 
> I do agree with you about the possibility of consulting with medical direction while still on scene.  I would be curious what a doc would say if they recv'd a call with this infomation.



Patient was in a dune buggy traveling at a high rate of speed that crashed. Patient was not wearing a seatbelt and was ejected. (Thats the just of what happened). That sounds like a blunt trauma arrest to me. Patient was rolled over by PD and found to have no pulse and not breathing.

Blunt trauma arrest with a rhythm of constant asystole or PEA of less than 10 is grounds for a medic to call the patient DOA.

http://www.remsa.us/policy/

Treatment policy 4203 Do Not Attempt Resuscitation / Discontinue Resuscitation
First treatment box listed as #9.

If CPR has already been started we have to make base hospital contact in order to discontinue working the full arrest. If no one has started CPR we do not have to make base hospital contact to call the patient.


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## Darwin (Jun 23, 2013)

paccookie said:


> Your pt is a 16 y/o female who was ejected from a dune buggy. The dune buggy also *landed on her, although you cannot tell exactly how.*





Tigger said:


> Blunt trauma by way of the a several hundred pound vehicle *to the chest* is not going to just magically do no significant harm.



This is scary.

I do let me emotions get somewhat involved in calls on children, and they should as long as it doesn't interfere with treatment, but my passion for this topic is for this thread specifically for the reason I just showed, and has been flooded in this thread, jumping to conclusions based on a topic that is very unpopular with most members here in general, working a traumatic arrest.


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## Akulahawk (Jun 23, 2013)

What I am going to do is highlight those portions of the original post that made me think that this patient should not be worked. My own comments will be in red.





paccookie said:


> Your pt is a 16 y/o female who was *ejected from a dune buggy*. MOI = poor indicator, ejection is not good... *The dune buggy also landed on her*, although you cannot tell exactly how. No seat belts were worn. Unknown speed. Vehicle went off the pavement and rolled into a ditch. Your pt was initially found prone in the ditch and rolled over by pd to be* found pulse less and apneic*. *CPR was started* although pd believed your pt to be doa.
> 
> You and your partner arrive and immediately begin working and packaging your pt. obvious swelling noted to the cervical spine both anteriorly and posteriorly. Eyes are beginning to swell and appear raccoon like.* Bleeding from the mouth and nose and right ear.* This tells me likely massive skull injury with blood vessel damage. No other immediate trauma noted. Pt has blood in her airway.
> 
> ...


These are the things that, in total, all add up to me saying this patient is dead on scene and shouldn't be worked at all.


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## Darwin (Jun 23, 2013)

DesertEMT66 said:


> Patient was in a dune buggy traveling at a high rate of speed that crashed.



Where did you see high rate of speed?  If you have this in your report and the officer has "unknown speed" in his report as it says in the original post and it went to court you would get f'ing hammered on the stand.


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## Aidey (Jun 23, 2013)

What is scary? 

The prevailing opinion on working blunt traumatic arrests here is based on studies that have shown over 99% of them stay dead. We are not basing our opinion on emotion.

Edit: In addition to what Akula highlighted 





> *packaging your pt. obvious swelling noted to the cervical spine both  anteriorly and posteriorly. Eyes are beginning to swell and appear  raccoon like*


 This patient has massive head and neck trauma. Even if all her other systems are intact, I suspect there was sufficient damage to her central nervous system to result in irreversible death.


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## DesertMedic66 (Jun 23, 2013)

Darwin said:


> Where did you see high rate of speed?  If you have this in your report and the officer has "unknown speed" in his report as it says in the original post and it went to court you would get f'ing hammered on the stand.



Misread the OP and I highly doubt I would get "f'ing hammered" if for some reason this call went to court.


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## Akulahawk (Jun 23, 2013)

Darwin said:


> Cause of arrest:  you are 100% sure based on the information given?  You have no doubt at all that it was not airway compromise?
> 
> Obvious signs of death:  can you show me where this is listed in any protocol?
> 
> I do agree with you about the possibility of consulting with medical direction while still on scene.  I would be curious what a doc would say if they recv'd a call with this infomation.


How about I show you the determination of death protocol for my county... and others I'm familiar with are _very_ similar...

Sacramento County Policy # 2033.11
Definitions: 
3. Absence of palpable pulses is the absence of pulses after palpating for carotid pulses for at least ten (10) seconds.
4. Asystole by monitor is the attachment of leads and the running of at least six (6) second strips in two (2) different leads. Asystole is the absence of ALL cardiac electrical activity
5. Rigor Mortis - The stiffness seen in corpses. Rigor mortis begins with the muscles of mastication and progresses from the head down the body affecting legs and feet last (Tabor's). Generally manifested in one (1) - six (6) hours and maximum six (6) - twenty-four (24) hours.

EMT or Paramedic Findings

5. Rigor Mortis: physical examination of jaw and one limb with findings of rigor.
 Paramedic only: 
2. The patient has no life signs and *Rigor Mortis* and/or Livor Mortis cannot be assessed or is difficult to assess.
a. Skin temperature is the same as the ambient temperature.
b. Asystole by monitor in two (2) leads.
3. Traumatic injuries (if appropriate; respect the possibility of a crime scene):
a. *Absence of all pulses*, and
b. *Asystole *by monitor in two (2) leads, or
c. Pulseless electrical activity (PEA) at a rate of less than or equal to 40 beats per minute.


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## Darwin (Jun 23, 2013)

Aidey said:


> What is scary?
> 
> The prevailing opinion on working blunt traumatic arrests here is based on studies that have shown over 99% of them stay dead. We are not basing our opinion on emotion.
> 
> Edit: In addition to what Akula highlighted  This patient has massive head and neck trauma. Even if all her other systems are intact, I suspect there was sufficient damage to her central nervous system to result in irreversible death.



It's scary that he read the vehicle landed on her chest when it was stated in the original post that you cannot tell exactly how.  Everyone on here is assuming the arrest is related to the trauma but I pointed out the possibility of respiratory arrest which is by all means a reasonable doubt and should be given strong consideration.  It could be irreversible neuro damage, or an aneurysm, or a number of things...but we don't know that so don't assume the worst as an excuse to get out of working a code, and that is what I am hearing here.

My whole point is that there is this thought that based on statistics, trauma arrests should not be worked (which to a certain extent, I do agree with) but everyone on here is seeing trauma and jumping on this right away as the reason for arrest and not looking outside the box.  If this is happening on real calls than there is an issue with complacency that is depriving people life when there is a chance.


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## DesertMedic66 (Jun 24, 2013)

Darwin said:


> It's scary that he read the vehicle landed on her chest when it was stated in the original post that you cannot tell exactly how.  Everyone on here is assuming the arrest is related to the trauma but I pointed out the possibility of respiratory arrest which is by all means a reasonable doubt and should be given strong consideration.  It could be irreversible neuro damage, or an aneurysm, or a number of things...but we don't know that so don't assume the worst as an excuse to get out of working a code, and that is what I am hearing here.
> 
> My whole point is that there is this thought that based on statistics, trauma arrests should not be worked (which to a certain extent, I do agree with) but everyone on here is seeing trauma and jumping on this right away as the reason for arrest and not looking outside the box.  If this is happening on real calls than there is an issue with complacency that is depriving people life when there is a chance.



You're giving the illusion that these patients "have a chance" when in reality they do not.

You're trying to say the patient when into full arrest due to swelling on her neck that possibly closed the airway. Based on your argument here about swelling we could also say the swelling was caused by an allergic reaction and the cause of the full arrest was due to anaphylactic shock which lead to other chain reactions.

It's hard to look outside the box when all the evidence on scene and patient presentation is pointing inside the box. If we are thinking outside of the box the patient could have had a PE which caused the driver to lose control and crash. I can keep coming up with "outside of the box" answers but I hope I don't have top.


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## Medic Tim (Jun 24, 2013)

Taking any chest trauma and the buggy landing on the pt I would still call it. Asystole after being ejected from an mvc with a basal skull fracture and rigor setting in. Pretty clear cut that this pt is dead and there is nothing we or anyone else can do.


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## Akulahawk (Jun 24, 2013)

Darwin said:


> Where did you see high rate of speed?  If you have this in your report and the officer has "unknown speed" in his report as it says in the original post and it went to court you would get f'ing hammered on the stand.


Personally I wouldn't write "high rate of speed" but I would likely write something to the effect of "patient was ejected from, and rolled on top of by  dune buggy. Patient and  dune buggy were found in a ditch. PD stated they found patient face down in the ditch, rolled the patient over and did not find a pulse, started CPR. (If known) Down time is xx minutes prior to PD arrival, and xx minute prior to our arrival on scene." 

Somehow, I doubt  documenting that particular call like that would probably not get me hammered in court. Why? That would be because I am specifically highlighting the very reasons why I had determined death in the field.


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## Darwin (Jun 24, 2013)

DesertEMT66 said:


> Misread the OP and I highly doubt I would get "f'ing hammered" if for some reason this call went to court.



Yes you would...

First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.

And if you made a determination to withhold treatment based on an MOI that included a rate of speed that you assumed, and there were other possibilities for survival presented, then yes...hammered.

If you misread the OP, how many times have you misunderstood an on-scene report in the same manner?


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## chaz90 (Jun 24, 2013)

Man, I'm trying to resist the urge to pile on here. This has really been covered pretty well by Akulahawk, Aidey, and everyone else who has posted.

Blunt trauma arrests do not survive. Yes, you can carry on and bring up some anecdotal story of a miracle save that you once heard happened when the stars aligned and it was a full moon on the third Thursday of a month. Overall, this is not a salvageable patient. I have nothing against working a code, and I resent the suggestion that determining a patient is not viable represents any kind of laziness. Don't mistake knowledge and pragmatism for ignorance and laziness. 

To suggest that this arrest may have been caused by anything else other than the severe blunt trauma is patently absurd. Healthy 16 YOF was out riding dune buggies when she was ejected at high speed and one fell on top of her, and she is now pulseless, apneic, and asystolic. A leads to B, and looking around for some kind of bizarre zebra makes no sense at all. 

Working a non viable code because not doing so would mean "not giving it your all" or "taking away whatever chance they have" shows a huge misunderstanding of what has happened here. This patient (body) no longer has a chance. Quite honestly, they would probably be dead from this injury if they were lying in an OR with a team ready when an ATV fell from the sky and produced these same injuries.


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## DesertMedic66 (Jun 24, 2013)

Darwin said:


> Yes you would...
> 
> First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.
> 
> ...



I don't make any determinations based solely on MOI as it is an unreliable indicator. 

How many times have you accidentally said something? Small mistakes like this happen especially since I am doing multiple things right now and not just focused on typing (when I write ePCRs that is all I'm doing). 

Also to add in you might want to drop the personal attacks before this thread gets closed down by a Mod.


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## ffemt8978 (Jun 24, 2013)

I'd suggest some people take a few moments, step back from this thread, and take a deep breath before their attitudes get them in trouble here.


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## Darwin (Jun 24, 2013)

Medic Tim said:


> Taking any chest trauma and the buggy landing on the pt I would still call it. Asystole after being ejected from an mvc with a basal skull fracture and rigor setting in. Pretty clear cut that this pt is dead and there is nothing we or anyone else can do.



Chest trauma?  Where do you see this?  I only see it where everyone else is jumping to conclusions.

I will give on the rigor but it didn't start until after treatment was started and noticed it "starting" after attempting to establish an airway.  That is the only obvious sign of death but a question for the OP, was it there when you started working this pt?


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## DesertMedic66 (Jun 24, 2013)

Darwin said:


> Chest trauma?  Where do you see this?  I only see it where everyone else is jumping to conclusions.
> 
> I will give on the rigor but it didn't start until after treatment was started and noticed it "starting" after attempting to establish an airway.  That is the only obvious sign of death but a question for the OP, was it there when you started working this pt?



As 2 protocols (the 2 that were posted) stated asystole on a blunt trauma arrest is an obvious sign of death.


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## Akulahawk (Jun 24, 2013)

Darwin said:


> Yes you would...
> 
> First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.
> 
> ...


Something that you should remember is that it takes a fairly significant amount of energy to eject someone from a vehicle. Typically that means the vehicle is either going at a fairly significant speed or the vehicle is rolling at a fairly significant rate, which is usually indicative of either a pretty good fall down a ledge of some sort or it required some sort of acceleration like perhaps the vehicle was going at some speed >0 at the time of rollover and subsequent ejection from the vehicle. This is regardless of whether or not the patient was wearing a seatbelt.

As others have indicated, including myself, mechanism of injury is a poor predictor of actual injury, but it is a very good predictor of where to look for it. When you have an ejection from a vehicle, with evidence that the vehicle rolled on top of the patient, no vital signs, significant head trauma and neck trauma, rigor mortis is starting to occur, with asystole on the monitor, that is a pretty good indicator that the patient is well and truly dead. I would further imagine that the cervical area swelling that was observed is simply a large hematoma that occurred subcutaneously and is due to the same mechanisms that caused the massive head trauma with all of the hemorrhage and airway obstruction that occurred with that trauma.

This patient is well and truly dead, and has received injuries that are very much incompatible with life. The patient is dead on scene, should be documented as such, and the body should be turned over to the custody of law enforcement so that they can in turn turn over custody of the body to the corner.


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## Darwin (Jun 24, 2013)

DesertEMT66 said:


> Also to add in you might want to drop the personal attacks before this thread gets closed down by a Mod.


There have been no personal attacks.  I explained what would happen in court.


ffemt8978 said:


> I'd suggest some people take a few moments, step back from this thread, and take a deep breath before their attitudes get them in trouble here.


I personally don't see any rage, name calling, or anything outside of an honest debate here.


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## Medic Tim (Jun 24, 2013)

Darwin said:


> Chest trauma?  Where do you see this?  I only see it where everyone else is jumping to conclusions.
> 
> I will give on the rigor but it didn't start until after treatment was started and noticed it "starting" after attempting to establish an airway.  That is the only obvious sign of death but a question for the OP, was it there when you started working this pt?



You were saying in several posts that the pt being crushed by the buggy was uncertain and we cant base calling the pt because of it.I was just pointing out that it really makes no difference in this case. Pt had injuries incompatible with life.


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## Mariemt (Jun 24, 2013)

Darwin said:


> Yes you would...
> 
> First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.
> 
> ...



Her lungs were full....of what? Blood? No matter what the speed, she had traumatic injuries incompatible with life. Bleeding from the ear, nose, mouth. Swelling posterior and anterior c spine.  

Injuries incompatible with life. Throw in the rigor and you are working a dead body. Let the child rest.


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## Carlos Danger (Jun 24, 2013)

Darwin said:


> Obvious signs of death:  can you show me where this is listed in any protocol?



This appears in every EMS arrest protocol I've ever seen.

Are you brand new to EMS?


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## exodus (Jun 24, 2013)

Darwin said:


> Cause of arrest:  you are 100% sure based on the information given?  You have no doubt at all that it was not airway compromise?
> 
> Obvious signs of death:  can you show me where this is listed in any protocol?
> 
> I do agree with you about the possibility of consulting with medical direction while still on scene.  I would be curious what a doc would say if they recv'd a call with this infomation.



Right here, number 9:

http://www.remsa.us/policy/4203.pdf

Dude, just give it up. You *are* wrong here and are just going in circles.


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## usalsfyre (Jun 24, 2013)

Darwin said:


> Yes you would...
> 
> First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.


Unless you're a lawyer of have been "f'ing hammered" on the stand for similar reasons I wouldn't exactly be so sure. 



Darwin said:


> And if you made a determination to withhold treatment based on an MOI that included a rate of speed that you assumed, and there were other possibilities for survival presented, then yes...hammered.


I don't think most people here are really using MOI as "the" deciding factor. Probably more like that pesky little cardiac arrest in the presence of severe blunt trauma.....



Darwin said:


> If you misread the OP, how many times have you misunderstood an on-scene report in the same manner?


You seemed to have missed the part about "chest rise and fall" which would tend to eliminate the airway obstruction argument. Pot...meet kettle....

I sincerely hope if God forbid this was my child someone capable of making calm and rational decisions responded, not someone who was was ruled by the emotion of serious injury to a child and more concerned with putting the "care" in healthcare than managing a resuscitation appropriately.


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## Tigger (Jun 24, 2013)

I wasn't being rhetorical. Actually give a pediatric trauma score to this patient. Then go look at the mortality rate based on score. That's actual real science, not anecdotal crap.


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## Wheel (Jun 24, 2013)

Just to make sure this is here, I figured it as this.

Weight: over 20kg                      +2
Airway: unmaintainable               -1
Systolic BP: <50mmhg.               -1
CNS: unresponsive                      -1
Fractures: closed or suspected.    +1 (none mentioned, but I expect them)
Wounds: major, blood in airway    -1
_____________________________________________________________
                                                  -1

This is how I figured it according to the document I found (first result in google search.) I supposed you could fudge it and make the number higher, and I made a couple of assumptions that weren't explicitly mentioned in the OP. The site states that a pts of less than 0 is estimated at a 100% mortality rate.

From here: http://www.thechildren.com/trauma/_pdf/en/assessing-trauma-severity.pdf


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## Tigger (Jun 24, 2013)

That's pretty much what I came up with.


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## VFlutter (Jun 24, 2013)

Darwin said:


> ...



So you work and transport this patient...then what? What do you think they are going to do in the ER? Most trauma surgeons wouldn't even touch the patient and would call it on arrival. They may try to keep them alive long enough to get consent for organs, if that makes you feel any better?

You think they are going to open her chest? In an academic trauma center they might but at that point it is not to save the patient but rather a practice run and anatomy lesson.


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## exodus (Jun 24, 2013)

Chase said:


> So you work and transport this patient...then what? What do you think they are going to do in the ER? Most trauma surgeons wouldn't even touch the patient and would call it on arrival. They may try to keep them alive long enough to get consent for organs, if that makes you feel any better?
> 
> You think they are going to open her chest? In an academic trauma center they might but at that point it is not to save the patient but rather a practice run and anatomy lesson.



Kinda like here: http://vimeo.com/49527742

They got a patient in with a cut in his femoral artery. Homeboy amberlamps to the ER, by the time he's rolled in, he's DOA asystole, not even any blood left in him. Surgeons start compression, crack his chest, do their cardiac workup with bloods and everything and get stable pulses back. Pt is discharged to a facility for rehab. Not sure HOW mentally disabled he is, but the way it makes it sounds, he's alert.


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## Tigger (Jun 24, 2013)

exodus said:


> Kinda like here: http://vimeo.com/49527742
> 
> They got a patient in with a cut in his femoral artery. Homeboy amberlamps to the ER, by the time he's rolled in, he's DOA asystole, not even any blood left in him. Surgeons start compression, crack his chest, do their cardiac workup with bloods and everything and get stable pulses back. Pt is discharged to a facility for rehab. Not sure HOW mentally disabled he is, but the way it makes it sounds, he's alert.



Kind of apples to oranges though, don't you think? The above patient does not have multi-system destruction as a result of blunt trauma, making him a bit easier to manage I'd imagine.


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## exodus (Jun 24, 2013)

Tigger said:


> Kind of apples to oranges though, don't you think? The above patient does not have multi-system destruction as a result of blunt trauma, making him a bit easier to manage I'd imagine.



Oh, I wasn't posing an argument, I just thought it was a cool thing to watch and kinda worked for what you were saying


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## Akulahawk (Jun 24, 2013)

exodus said:


> Kinda like here: http://vimeo.com/49527742
> 
> They got a patient in with a cut in his femoral artery. Homeboy amberlamps to the ER, by the time he's rolled in, he's DOA asystole, not even any blood left in him. Surgeons start compression, crack his chest, do their cardiac workup with bloods and everything and get stable pulses back. Pt is discharged to a facility for rehab. Not sure HOW mentally disabled he is, but the way it makes it sounds, he's alert.


This is one of those very rare occasions when you have a trauma team ready to go, a patient that's got _some_ blood still in the body, and they're able to save him (for the minute) because he probably lost his vital signs right about the time he was dragged into the ED. I would imagine that had his aorta been transected, they'd be telling a totally different story. 

Furthermore, nobody in the scenario at hand in this thread is very likely to crack the patient's chest, attempt to clamp the aorta and go to town because there's still some very significant wounds that would continue to bleed even with the aorta clamped. 

There's such a thing as non-survivable injury. The patient in this scenario is one such case.


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## Akulahawk (Jun 24, 2013)

exodus said:


> Oh, I wasn't posing an argument, I just thought it was a cool thing to watch and kinda worked for what you were saying


Very interesting case... but that case just isn't the same as the scenario case, for a whole host of reasons.


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## Carlos Danger (Jun 24, 2013)

Tigger said:


> Kind of apples to oranges though, don't you think? The above patient does not have multi-system destruction as a result of blunt trauma, making him a bit easier to manage I'd imagine.



Penetrating vs. blunt trauma _is_ apples and oranges.

In the video you have a patient with a *focal injury* and probably a short pulseless time. Stop the bleeding by clamping the aorta, pump him full of blood, start his heart, and as long as he wasn't pulseless for too long, he is stabilized and may recover.

In the scenario the OP posted, however, you have a patient with a history and clinical signs suggestive of both massive *diffuse* CNS injury, which cannot be repaired, AND thoracic trauma, AND likely and a much longer down time.

Very different injury patterns and circumstances.


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## ffemt8978 (Jun 24, 2013)

Not to mention the unknown time from injury onset to EMS arrival, plus the 6-7 minutes minimum to get to the local doc in the box or 12-15 minutes to get to the trauma center.

So what we're dealing with is a patient who has no pulses for an absolute minimum of 15 minutes (assuming, of course, that EMS only spends 10 minutes on scene) before they arrive at a hospital, and more likely 30-45 minutes.


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## paccookie (Jun 24, 2013)

Akulahawk said:


> This is one of those very rare occasions when you have a trauma team ready to go, a patient that's got _some_ blood still in the body, and they're able to save him (for the minute) because he probably lost his vital signs right about the time he was dragged into the ED. I would imagine that had his aorta been transected, they'd be telling a totally different story.
> 
> Furthermore, nobody in the scenario at hand in this thread is very likely to crack the patient's chest, attempt to clamp the aorta and go to town because there's still some very significant wounds that would continue to bleed even with the aorta clamped.
> 
> There's such a thing as non-survivable injury. The patient in this scenario is one such case.



Agreed. However the trauma center has the ability to harvest organs and the local hospital does too but very rarely ever does harvest organs. A trauma team would've been in place upon arrival and the parents would've had that option if anything was viable. Turns out this pt had an atlanto-occipital dislocation. We took her to the local hospital. Worked her primarily because her mother was on scene. And honestly if it had been my child, I would want everything possible done. The local hospital stabilized her airway using a fiber optic scope and managed to get a pulse and a blood pressure and then transferred her to the trauma center. As its 15 minutes away, that's a ground transport. She went on an epi drip and made it there, only to arrest again 15 minutes later.


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## firecoins (Jun 24, 2013)

Take them to a hospital.


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## Akulahawk (Jun 24, 2013)

paccookie said:


> Agreed. However the trauma center has the ability to harvest organs and the local hospital does too but very rarely ever does harvest organs. A trauma team would've been in place upon arrival and the parents would've had that option if anything was viable. Turns out this pt had an atlanto-occipital dislocation. We took her to the local hospital. Worked her primarily because her mother was on scene. And honestly if it had been my child, I would want everything possible done. The local hospital stabilized her airway using a fiber optic scope and managed to get a pulse and a blood pressure and then transferred her to the trauma center. As its 15 minutes away, that's a ground transport. She went on an epi drip and made it there, only to *arrest again 15 minutes later*.


I wonder how long that interval was between initiating transport and ROSC at the closest facility... followed by about 30 minutes of ROSC and demise.

I also wonder what organs may have been considered for donation given the amount of time where there was no blood flow...


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## Jim37F (Jun 24, 2013)

paccookie said:


> Turns out this pt had an atlanto-occipital dislocation.


Isn't that where the skull separates from the spinal column?


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## VFlutter (Jun 24, 2013)

Akulahawk said:


> I also wonder what organs may have been considered for donation given the amount of time where there was no blood flow...



And then followed by an Epi drip :blink: Maybe the corneas were still viable?


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## Nattens (Jun 24, 2013)

Jim37F said:


> Isn't that where the skull separates from the spinal column?



Correct, also called an Internal Decapitation. Very poor prognosis that only few have survived.


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## Akulahawk (Jun 24, 2013)

Jim37F said:


> Isn't that where the skull separates from the spinal column?


In a manner of speaking, yes. The skull dislocates off the 1st vertebrae (aka the Atlas). It also may or may not result in separation of the spinal cord from the brain, which is also a very bad thing. :blink:


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## Akulahawk (Jun 24, 2013)

Chase said:


> And then followed by an Epi drip :blink: Maybe the corneas were still viable?


I was thinking the same thing, actually.


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## chaz90 (Jun 24, 2013)

Akulahawk said:


> It also may or may not result in separation of the spinal cord from the brain, which is also a very bad thing. :blink:



Eh, definitely sounds like something that could just be plugged back in at the trauma center. That's how it works right?


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## DesertMedic66 (Jun 24, 2013)

chaz90 said:


> Eh, definitely sounds like something that could just be plugged back in at the trauma center. That's how it works right?



Like an extension cord right?


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## VFlutter (Jun 24, 2013)

DesertEMT66 said:


> Like an extension cord right?



Obviously a Nursing procedure.


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## DesertMedic66 (Jun 24, 2013)

Chase said:


> Obviously a Nursing procedure.



Pretty sure it's an LVN skill in my neck of the woods :rofl:


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## Akulahawk (Jun 24, 2013)

Just wait... eventually they'll just delegate it to a CNA. You know, part of "keeping the lights on."


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## ffemt8978 (Jun 24, 2013)

Akulahawk said:


> Just wait... eventually they'll just delegate it to a CNA. You know, part of "keeping the lights on."



And once the CNA's get that skill, it's only a matter of time before it becomes a Basic procedure that the NREMT tests on.


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## paccookie (Jun 25, 2013)

Chase said:


> And then followed by an Epi drip :blink: Maybe the corneas were still viable?



And that's exactly why I prefer to transport straight to a facility that can skip the unnecessary stabilize for transport to the appropriate facility step. I've seen this hospital do this sort of thing more than once and it could be avoided with properly written protocols. Not just for peds pts. But non survivable head trauma as a whole - gsws to the head would be a good example. Isolated head trauma = good potential for organ donation. It sucks to think of it that way but there are so many people waiting for healthy organs. I guess I think about these things differently than most people.


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## paccookie (Jun 25, 2013)

ffemt8978 said:


> Not to mention the unknown time from injury onset to EMS arrival, plus the 6-7 minutes minimum to get to the local doc in the box or 12-15 minutes to get to the trauma center.
> 
> So what we're dealing with is a patient who has no pulses for an absolute minimum of 15 minutes (assuming, of course, that EMS only spends 10 minutes on scene) before they arrive at a hospital, and more likely 30-45 minutes.



The call came in about a minute after it happened as there was another person in the dune buggy and at least two bystanders. Response time for EMS was 4 minutes. Pd was on scene doing CPR withing 5 minutes of the initial call to 911.


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## Carlos Danger (Jun 25, 2013)

paccookie said:


> A*nd that's exactly why I prefer to transport straight to a facility that can skip the unnecessary stabilize for transport to the appropriate facility step.* I've seen this hospital do this sort of thing more than once and it could be avoided with properly written protocols. Not just for peds pts. But non survivable head trauma as a whole - gsws to the head would be a good example. Isolated head trauma = good potential for organ donation. It sucks to think of it that way but there are so many people waiting for healthy organs. I guess I think about these things differently than most people.



Yeah, I hate it when facilities stabilize my patients, too.....

You'll have to change EMTALA if you want them to stop doing that crazy stuff.


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## paccookie (Jun 25, 2013)

Halothane said:


> Yeah, I hate it when facilities stabilize my patients, too.....
> 
> You'll have to change EMTALA if you want them to stop doing that crazy stuff.


My point was to transfer to the closest appropriate facility rather than just the closest facility.


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## DesertMedic66 (Jun 25, 2013)

paccookie said:


> My point was to transfer to the closest appropriate facility rather than just the closest facility.



The closest most appropriate facility in this case (full arrest with an unsecured airway) is the closest hospital to your location.


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## Handsome Robb (Jun 25, 2013)

Will your non trauma facilities accept traumatic arrests? 

Ours won't, we get diverted, that's why if we're greater than a few minutes from the TC it gets pronounced unless its a penetrating trauma then they usually get worked and transported.


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## DesertMedic66 (Jun 25, 2013)

Robb said:


> Will your non trauma facilities accept traumatic arrests?
> 
> Ours won't, we get diverted, that's why if we're greater than a few minutes from the TC it gets pronounced unless its a penetrating trauma then they usually get worked and transported.



For us, full arrests go to the closest regardless.


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## VFlutter (Jun 25, 2013)

For most academic facilities Traumatic Arrest = Cadaver Lab


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