Cardiac Arrest Question?

[ThatGirlLex4]

I'm with Gurby on this one... You could have done worse. Take this experience, learn from it and allow it to make you a stronger EMT, rather than a nervous one I think you did right by your patient and will continue to do so throughout your career!

Thanks Probie I am definitely learning a lot from this situation and will carry this lesson with me for the rest of my life. I really hope this just turns me into a stronger EMT.

 

[Tigger]

I know I am coming off defensive, but I feel really uneasy about the whole thing. I was driving and made the decision to rush to the ER, which the dispatcher ok'ed. If I had known it would have been more beneficial to the pt to stop, I, of course, would have. I am in this field to help patients in the best way I know how, but I can't do what I don't know. Now, I do know... so it's something, I guess. I guess I can find some peace of mind in the fact that the ER told me there was nothing that could be done, but I have knot in the pit of my stomach about it.

Being defensive is not conducive to receiving feedback. As our careers progress, we make mistakes and we will answer and learn from them. Take constructive criticism (which this all is), and use it to do better next time. Generally speaking, single provider CPR in the back of a moving ambulance is not something that should be done.

Being able to justify your actions is important as well, and you've done that. Props to you for that considering where you're at career wise.

 

[ThatGirlLex4]

Being defensive is not conducive to receiving feedback. As our careers progress, we make mistakes and we will answer and learn from them. Take constructive criticism (which this all is), and use it to do better next time. Generally speaking, single provider CPR in the back of a moving ambulance is not something that should be done.

Being able to justify your actions is important as well, and you've done that. Props to you for that considering where you're at career wise.

Thank you and yes, you're 100% right. Being able to take criticism is a huge part of any career, especially at the beginning. Believe me when I say that I have learned so much just from this one experience alone. Thanks again Tigger

 

[Chewy20]

Don't feel like reading through all the posts. But if this hasn't been said then here you go. Cardiac arrest is NOT a load and go situation. 9 minutes in the back of a moving ambulance with one provider is heavily putting the odds against the pt. I can't blame two new providers at the BLS level. But now you know, pull over, get something sturdy under the pt and start high quality CPR until ALS arrives. The concept of not working an arrest on scene has been argued on this site before and it makes no sense to make things harder trying to rush to hospital. The pts best shot at getting undead is on scene. If you can't get them back. Call for a time of death. I've worked an arrest literally at the doors of the ambulance bay on the pavement when someone drove up with the pt. in the car. The doctors let us do our thing until we got ROSC.

 

[LACoGurneyjockey]

You're asking for feedback, and that's a good thing. As everyone has already said, you did just fine. Take this experience and learn from it, and next time you'll be even better. This patient probably had a poor prognosis anyway, even with immediate ALS. People die, that's part of life. It's not your fault, so don't beat yourself up over it. I go back and look at some of the questions I asked on here as a brand new EMT and now I think they were pretty stupid. But that's being new, and you're taking the initiative to seek out a learning experience and use it to better your self. There's plenty of EMTs who would just brag about their cool call and be sure they did everything perfect.
You did fine, keep going forward and leaning from everything. That's part of being new.

 

[Matt Alcon]

Any time their is a cardiac arrest during transport, you should automatically stop the ambulance and assist your partner. 2 person CPR is better than 1.

 

[johnrsemt]

Stop the truck, call for ALS, make sure your partner has started CPR, get the AED and use it.

Only benefit about continuing to the hospital is that the patient doesn't die in your truck. If ALS arrives and works him while sitting and they call and get permission to call the patient in the truck you are stuck with the body until the ME clears him and the scene.

 

[Chewy20]

Stop the truck, call for ALS, make sure your partner has started CPR, get the AED and use it.

Only benefit about continuing to the hospital is that the patient doesn't die in your truck. If ALS arrives and works him while sitting and they call and get permission to call the patient in the truck you are stuck with the body until the ME clears him and the scene.

Arnt they already dead if they code in the back of your truck?

 

[triemal04]

Arnt they already dead if they code in the back of your truck?

No only mostly dead...so sayeth Miracle Max!

 

[Tigger]

Stop the truck, call for ALS, make sure your partner has started CPR, get the AED and use it.

Only benefit about continuing to the hospital is that the patient doesn't die in your truck. If ALS arrives and works him while sitting and they call and get permission to call the patient in the truck you are stuck with the body until the ME clears him and the scene.

In some places. We do not do that here. It is not feasible to remove an ambulance from service so the ME can come "examine" the ambulance. We take the body to the station or hospital and leave it for them to come get. Extenuating circumstances exist, but for the most part we don't get stuck.

 

[NTXFF]

In some places. We do not do that here. It is not feasible to remove an ambulance from service so the ME can come "examine" the ambulance. We take the body to the station or hospital and leave it for them to come get. Extenuating circumstances exist, but for the most part we don't get stuck.

For us we either work them and call them at home depending on circumstances or transport. I could only imagine my chiefs face if I came back to the station!

 

[medicdan]

Think back to your CPR course... remember the only two interventions we provide that have evidence to support improving outcomes... High Quality Compressions and Defibrillation...

Many would argue that performing compressions in the back of a moving vehicle is unsafe - for the EMT and the patient. The provider is unrestrained and in a bad position if the vehicle is in a collision (see

and other videos on that account). That's also dangerous for the patient, because the compressions aren't high quality (think "Hard and Fast" from class). For a patient who has recently arrested, think about how you're going to defibrillate... remember that time to defibrillation is critical for survival.

ESRD/Hemodialysis patients are sick, all the time, in fact the sickest "barely stable" patients EMTs see on a regular basis. They are frequently in and out of hospitals, but however crappy they feel, still need their thrice weekly treatment.

 

[Parameduck]

You will never forget how to handle this situation in the future. It sucks. You did your best, learn from it.

 

[Bullets]

I think you did the right thing and i would have also continued to transport to a hospital. As the provider in the back i would have applied the AED and started uninterrupted compression unless the AED told me to shock.

By the time my dispatcher calls the ALS agency, they dispatch their unit, their medics get in the truck and on the road to me i could be at the hospital. And as said previously, if ALS arrives, and they pronounce in the rig, then the truck is OOS until the ME and PD do their invest. Since this was an "unexpected" death in LE eyes, the whole truck is a crime scene and will be investigated as such. But thats local to me, i know other places are different.

 

[chaz90]

I think you did the right thing and i would have also continued to transport to a hospital. As the provider in the back i would have applied the AED and started uninterrupted compression unless the AED told me to shock.

By the time my dispatcher calls the ALS agency, they dispatch their unit, their medics get in the truck and on the road to me i could be at the hospital. And as said previously, if ALS arrives, and they pronounce in the rig, then the truck is OOS until the ME and PD do their invest. Since this was an "unexpected" death in LE eyes, the whole truck is a crime scene and will be investigated as such. But thats local to me, i know other places are different.

It's not about "time to the hospital/ALS" though. By stopping and working this patient right now with quality BLS CPR (while motionless) and attempting defibrillation, this patient is getting the best chance at survival. Even if you are only 5 minutes from the hospital, that's 5 minutes in which poor moving compressions are being performed and motion artifact on analysis from the AED is entirely possible.

 

[18G]

Performing a high quality resuscitation is about focusing on quality compressions and defibrillation. One person cannot perform a quality resuscitation during transport. If you want to give your patient the best chance of survival a high quality resuscitation MUST occur. As others have recommended, if your patient CODES during transport, find a safe place to pull over and work the CODE together while calling for ALS. A cardiac arrest is not a "load and go". Anyone who tells you otherwise needs to be retrained.

I have had this exact conversation with my partners. Our game plan is if a patient CODES during transport the ambulance is being pulled over and we're working the CODE in the back until a provider shows up to drive us to the hospital. Another thing to think about is immediate defibrillation. If you witness your patient arrest and have the AED inches from you, do you start CPR or immediately apply the AED? Apply the AED. It's the electricity that will obtain ROSC at that point.

 

[Tigger]

I think you did the right thing and i would have also continued to transport to a hospital. As the provider in the back i would have applied the AED and started uninterrupted compression unless the AED told me to shock.

By the time my dispatcher calls the ALS agency, they dispatch their unit, their medics get in the truck and on the road to me i could be at the hospital. And as said previously, if ALS arrives, and they pronounce in the rig, then the truck is OOS until the ME and PD do their invest. Since this was an "unexpected" death in LE eyes, the whole truck is a crime scene and will be investigated as such. But thats local to me, i know other places are different.

Patients in cardiac rest that do not receive CPR very quickly do not do well. CPR in a moving ambulance by one person cannot be done well. Put those together and the patient will not do well, hospital or not.

 

[NTXFF]

Patients in cardiac rest that do not receive CPR very quickly do not do well. CPR in a moving ambulance by one person cannot be done well. Put those together and the patient will not do well, hospital or not.

I will give them props in they made a decision and stuck with it. Right, wrong, or indifferent making a decision is something for a lot of people that is extremely hard to do. I gave my two cents above but instead of focusing just on the things done wrong I wanted to give you props on something you did do.

 

[Tigger]

Sure. But the person I am replying to provided some rather flawed reasoning.

 

[NTXFF]

Sure. But the person I am replying to provided some rather flawed reasoning.

I didn't even mean to quote your post. My fault. I'm still new to this forum.