CPR and Moving Patients

[Emtgirl21]

one word here boys and girls "autopulse" God bless then man that invented that thing...i could give him hugs and kisses.

 

[SC Bird]

Is that the "geezer squeezer" I've heard so much about??

-Matt

 

[Ridryder911]

Let's get real... Someone HAS to make the determination if their going to get a chance or not. If they are in aystole (reason to do CPR) I give two rounds of med.'s with GOOD CPR for about 10 minutes... then that's it. This is a national recognized standard of care for progressive EMS and Emergency Department procedures. Aystole patients have poor to dismal outcomes (if you consider living on a vent .. living)

It is NOT just in the rural area codes have a < 10% chance; rather that is a National Average... scary part, hospital codes has a lower percentage.
Codes are futile, and as medicine finally progresses and realize that it is such, we will see more and more field termination.

R/r 911

 

[MedikErik]

I beg to differ, kind sir. I've seen people who were prime candidates to be brought back die, and those who were down for a while and "beyond hope" brought back. Only "The Man Upstairs" can determine who lives and dies, not us. Until someone who outranks me orders me to, I'm giving 110%.

 

[BossyCow]

If i had it my way, anyone in excess of 500 pounds overweight who's more than 1 flight of stairs up is considered to have an injury incompatible with life. Don't think the AHA would go for that, though...

We are covered on that one by the "our safety first" rule. We are never, ever to jeopardize our own safety to administer care to a pt. Jumping on a moving stretcher to give chest compressions is in my humble opinion, jeopardizing my personal safety. Trying to wedge myself through a doorway while giving probably ineffective chest compressions, is equally inappropriate.

I will do CPR as well as I can, as effectively as I can as long as to do so doesn't compromise my safety or the safety of those around me. Gotta remember, who's emergency is it?

I don't believe Rid is minimizing the responsiblity to do all we can to help our pts. I think its more of an evaluation of risk vs. gain.

 

[Ridryder911]

I am basing my outlook on current standards as stated by the Emergency Cardiac Care, and the American Heart Association for Advanced Cardiac Life Support. Physicians and research has demonstrated, cardiac arrests (especially those in aystole) are usually futile.

This has been known and demonstrated by research and clinical experience for years. If the patient does not respond by the second round of ACLS medications and agressive CPR, they will not. Why continue? This will be introduced more into the new standards as they come out.

There are several other special "situations" I do not go in heroic as well. Nursing home cardiac arrest (those that have outstanding medical history), as well as traumatic arrest are immediately called, and of those that are morbidity obesed. I do not have enough medications, as well as voltage to correct the problems. I agree, safety is included in my rational as well.

I am not acting solo on my decision, rather this is endoresed by my Medical Director. There are several studies and papers, suggesting the same from the Emergency Medical Services Physician/Directors Asssociation, Heart and Lung, Critical Care Quarterly, etc. One should introduce review and possibly introduce change to current standards to their medical director for possible protocol changes. Continuing to work predicatable cardiac arrest to the point of "no return" has possible problems, from unethical to needless costs and dangers to all.

R/r 911

 

[PArescueEMT]

I have to add my thoughts again... out here, we have to work EVERYTHING including obvious death (i.e. decapitation) Granted there are the calls that we know that there is no point, but you have to work them. When i go into a call, I look for the tell tale signs: Rigor, Dependant lividity, etc. 99% of the codes i have been on out here have been called pre-hospital. I can think of only one that we "saved" and he coded in the truck.

So if you know what you are looking for, that's when I say that it's okay to call it.

 

[BossyCow]

I have to add my thoughts again... out here, we have to work EVERYTHING including obvious death (i.e. decapitation) /QUOTE]

Okay, I admit I can be a bit odd at times, but my first thought here is... how do you check the airway on a decapitation?

 

[Meursault]

That just makes it easier: no tongue to get in the way, no worries about holding c-spine...

Even MA recognizes that working a code on anyone in multiple pieces is futile. Our standard is massive crush, decapitation, injuries like that, and, I think, a call to medical control. Medics get a bit more leeway.

 

[rgnoon]

I have to add my thoughts again... out here, we have to work EVERYTHING including obvious death (i.e. decapitation) Granted there are the calls that we know that there is no point, but you have to work them. When i go into a call, I look for the tell tale signs: Rigor, Dependant lividity, etc. 99% of the codes i have been on out here have been called pre-hospital. I can think of only one that we "saved" and he coded in the truck.

So if you know what you are looking for, that's when I say that it's okay to call it.

As per local protocols I assume?
We don't have to work a code with definitive signs of death ;obvious mortal damage(including decapitation), dependent lividity, rigor mortis, and putrefaction. And that is per state sop.

 

[PArescueEMT]

that would be county level B.S. but since i work on a PA card, i cheat and use PA protocol.

 

[MedikErik]

Maryland is quite similar.

Decapitation
Pulseless, apneic pt. with an injury incompatible with life (exception made for preg. females).
Rigor Mortis.
Dependent Lividity.
Decomposition.
Full-code in a MCI.

 

[Gbro]

Rid, said, and said, and says, and says,..........

I am not acting solo on my decision, rather this is endoresed by my Medical Director. There are several studies and papers, suggesting the same

When i use paper to determine when to start and when to stop, in place of my "GUT"
Than its time to bail.

I see on occasion someone who is walking around, still employed that was way outside any studies. I wasn't on that call, But we had an old EMT(kind of like where i am now(just in age, mind you)).
2 new ladies, just out of EMT basic, 1st Code for both. 32 (+/-)5years as its been a long time ago,
Pt went down unwitnessed in parking lot of store he managed(stress). 20 min. out of ER and no defibs anywhere in the field then.
CPR and when the crew left the ER pt was going up the elevator to ICU. 3-4 days in a coma, Pt. is in his >50's and still employed, doing great.

Now here is the kicker, The fossil(i can say that now) was the driver and these young ladies were using the new standard where one would pause to ventilate, He made this statement. " Those gals sure have a lot to learn about CPR"!, He was a CPR/EMT Instructor for many years prior!, But i think he thought more about what was in print, ,,,,,
my .02

 

[BossyCow]

There will always be the guy who's number isn't up yet. These are the exceptions. To attempt to write protocols based on that one in a thousand, odd case is not appropriate. I also feel to set up the expectation on every call that this call could be that one in a thousand is a path to EMS burnout. But I tend towards a more pragmatic view. I don't see death as an enemy to fight. Death is the completion of a life. None of us get out of here alive.

 

[Airwaygoddess]

It's true what BosseyCow said, everyone will have their time and place.......