cpr with bullet wound

tennisaceflink

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I just saw in a movie that they were doing CPR on someone with two bullet wounds to the chest, with no occlusive dressing over the wounds. One would think that if you were doing cpr you are pumping blood for them and since there is an open wounds the blood would just be pumped out of the body. I am a new EMT so i apologize if this question is dumb. Just got my emt card the other day lol
 

bigbaldguy

Former medic seven years 911 service in houston
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I just saw in a movie that they were doing CPR on someone with two bullet wounds to the chest, with no occlusive dressing over the wounds. One would think that if you were doing cpr you are pumping blood for them and since there is an open wounds the blood would just be pumped out of the body. I am a new EMT so i apologize if this question is dumb. Just got my emt card the other day lol
No pulses start CPR. Patch holes later. Even if you patched external holes there will be internal bleeding you can do nothing about.

Remember your priorities. CAB or ABC
 

errey

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I agree going by our protocols in Canada you start cpr its better to get the blood circulating right away rather than wait to patch. you could have a partner put a gloved hand over the wounds until you are able to patch if possible
 

bigbaldguy

Former medic seven years 911 service in houston
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Remember that an arrest is always an arrest and your main priority is saving the brain. To save the brain you need to get blood flowing. That said in this situation you wouldn't stay on scene and work the arrest obviously. Your main priority would be to get the guy to a trauma center ASAP.

Ok other than rapid fluid/blood product infusion why would you want to do your best to get two large bore IVs started on this guy as soon as possible?

First correct answer gets a patch :)
 

firetender

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As for your question, yes, I have had a multiple gun shot victim who went South on me, I began CPR and blood didn't exactly spurt out of the holes but it didn't ooze, either. More like bubbled without the air. Yup, I was fascinated; "Gee, it really works!"
 

RocketMedic

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Remember that traumatic arrest is almost always death. The best possible way you might make a difference is identifying a cause of arrest and treating that- in this case, your most likely three are hypovolemia from massive hemorrhaging, structural destruction, and pneumothorax. On a BLS level, we can seal the chest and do CPR, but that's a lot like rearranging deck chairs on the Titanic. On an ALS level, you can dart the chest (which may help) and infuse IV fluid (probably won't matter).

The most important thing you can do is manage your patient effectively and look for an H/T- you might get lucky. CPR is a holding measure.
 

Veneficus

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RocketMedic

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Thank you.
 

ExpatMedic0

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Pretty rare to even work a traumatic arrest. In my experience its only if they code after I have made patient contact.
 

Bullets

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Multiple gunshot wounds to the chest...injuries incompatible with life probably wouldnt work it in the first place
 

NYMedic828

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Consider the viability of this patient.

EMS protocol tells us to work the patient up. Realistically, get on the phone and get a pronouncement.

The cause of death is physical damage to body structures and or loss of substantial amounts of blood/heme. You won't fix this patient. A surgeon won't fix this patient. Jesus can't fix this patient.

Pronounce.
 

bigbaldguy

Former medic seven years 911 service in houston
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Multiple gunshot wounds to the chest...injuries incompatible with life probably wouldnt work it in the first place
Gunshot wounds to the chest are injuries incompatible with life? What are we assuming he was shot with a cannon.
 

bigbaldguy

Former medic seven years 911 service in houston
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Excellent video discussing gun shot wounds by an MD. Warning very graphic. Please ignore the dorky guy in the first 3 minutes.

[youtube]tku8YI68-JA[/youtube]
 

NYMedic828

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Gunshot wounds to the chest are injuries incompatible with life? What are we assuming he was shot with a cannon.
Gunshot wounds to the chest resulting in cardiac arrest are pretty incompatible with life to me.

How do you or anyone else plan to fix this patient? I don't know of a single person that has taken a patient in traumatic arrest to the hospital and had them survive. Actually I don't know of any traumatic arrest anywhere that has been revived. I'm sure its happened, but to a full life with mental capacity, I highly doubt it.

If a patient has suffered exsanguinating blood loss to the point of extremis no amount of chest compressions, saline and ventilations is going to bring them back.

I had a patient shot DIRECTLY in the heart. I had to transport him and perform CPR. Had the patient had textbook anatomy, the shot would of perfectly transected the heart. Absolutely ridiculous. But these are the patients we expect to save and our medical directors apparently believe it too.

A patient in traumatic arrest is not going to arrive in the ER, immediately go to surgery and be miraculously revived. Maybe if Vene was the surgeon but otherwise...come on...

Also, money is an issue. What physician in their right mind is going to send a patient in traumatic arrest to surgery?

There is a reason its called irreversible shock...
 
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bigbaldguy

Former medic seven years 911 service in houston
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Gunshot wounds to the chest resulting in cardiac arrest are pretty incompatible with life to me.

How do you or anyone else plan to fix this patient? I don't know of a single person that has taken a patient in traumatic arrest to the hospital and had them survive. Actually I don't know of any traumatic arrest anywhere that has been revived. I'm sure its happened, but to a full life with mental capacity, I highly doubt it.

If a patient has suffered exsanguinating blood loss to the point of extremis no amount of chest compressions, saline and ventilations is going to bring them back.

I had a patient shot DIRECTLY in the heart. I had to transport him and perform CPR. Had the patient had textbook anatomy, the shot would of perfectly transected the heart. Absolutely ridiculous. But these are the patients we expect to save and our medical directors apparently believe it too.

A patient in traumatic arrest is not going to arrive in the ER, immediately go to surgery and be miraculously revived. Maybe if Vene was the surgeon but otherwise...come on...

Also, money is an issue. What physician in their right mind is going to send a patient in traumatic arrest to surgery?

There is a reason its called irreversible shock...
So just to be clear if you find a guy on the sidewalk with two bullet holes in his chest no pulse you're not going to work him?
 

Medic Tim

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So just to be clear if you find a guy on the sidewalk with two bullet holes in his chest no pulse you're not going to work him?
Correct , though I am sure a lot of ppl I work with want would run it. Then again we are 15 min to a smaller community hospital and an hour to the nearest trauma center which is only a level 3 (not sure how it translates to the us trauma system)
 

ExpatMedic0

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why in the world would you work a trauma DOA?
 

Martyn

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Ok other than rapid fluid/blood product infusion why would you want to do your best to get two large bore IVs started on this guy as soon as possible?

First correct answer gets a patch :)
As the loss of blood increases the BP rises then falls, as the BP falls the veins/arteries shrink making it harder to get a stick
 

NYMedic828

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So just to be clear if you find a guy on the sidewalk with two bullet holes in his chest no pulse you're not going to work him?
In NYC I'm required to work him. But I will probably get on the phone and ask for a pronouncement instead of transport.

Why disturb the crime scene for no reason? Granted it isn't an immediately mortal injury but if it was bad enough to take a man's life, it isn't going to be fixed.
 
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