First Trauma Code

RocketMedic

RocketMedic

Californian, Lost in Texas
Messages
5,001
Reaction score
1,469
Points
113
65 yo m rolled his truck and was ejected. Lafort two fractured cranial vault with csf, drainage massive bleeding pulseless apnic on arrival. Attempted ett due to massive oral bleeding, missed, good combitube, transport. Not surviveable but great practice.. Learned a lot to improve on.
 
Your agency won't let you call a blunt traumatic arrest that was unwitnessed?
 
Rocketmedic said:
65 yo m rolled his truck and was ejected. Lafort two fractured cranial vault with csf, drainage massive bleeding pulseless apnic on arrival. Attempted ett due to massive oral bleeding, missed, good combitube, transport. Not surviveable but great practice.. Learned a lot to improve on.
Click to expand...

:blink:

I don't think that even counts as a traumatic arrest. That's just a good old fashioned corpse. I'm pretty sure it's illegal in most places to interfere with a corpse.
 
At least you gained something out of the experience.

As for protocols (at least in TX) some are backwards, some are progressive - and alot of them are seldom reviewed or changed once they're written.
 
Linuss said:
Your agency won't let you call a blunt traumatic arrest that was unwitnessed?
Click to expand...

That's what I was wondering as well.
 
In the two counties that I'm familiar with out here, if that patient is in a PEA < 40 or in asystole, the patient is determined dead right on the spot. If that patient is in any other rhythm, or the rate is greater than 40, full resuscitation measures must be done.
 
This would fit the "head trauma" portion of my "withholding resuscitation" protocol.

ImageUploadedByTapatalk1322971093.333216.jpg
 
In any event, a traumatic injury like that usually results in resuscitation practice...
 
If I would come up to that today, would I work it? No
If I would have come up to that 3 years ago, would have I worked it? Probably

When I first started working as a paramedic I was in the mindset that I could save everyone and everything. I soon realized that this is not so. I have worked a couple traumatic arrests over the years and not one has survived. I now believe our protocol on traumatic arrests :) If they meet the criteria for withholding resuscitation, I withhold it. You have to remember that there are always those "weird ones". If your gut says to start CPR, start CPR. Did I, or will I, ever get in trouble for starting CPR... heck no. Would I get in trouble for not starting CPR when I should have? You know it! And like you and others have said, it was practice.
 
Last edited by a moderator:
We recently had a case like that here in Afghanistan. It was a mid-20's local male who was PLOWED by a up-armored humvee while checking culverts. He had the whole nine yards- open skull fracture with all the fixin's, long bone fractures, and in what seemed like a peri-arrest bradycardia with agonal respirations. Not a true trauma arrest, but similar mechanism.

Some might consider him not survivable had they found him pulseless and apneic, but every case is different. Of course, in a mud hut in a third-world country vs. a stringent EMS agency with "mother may I?" guidelines, the choice to resuscitate may not be so clear.

After an RSI [with atropine included in the premedication phase], F.A.S.T exam,and all the immobilization mumjo-jumbo, and a mack-truck of broad-spectrum antibiotics, he was flown out to a CASH with neurosurgical capabilities. Two days later, he was awake and talking in his bed. This was approximately two hours after the point of injury.

If anyone wants more information on the drugs used, or discuss the R.S.I choice on someone with a GCS of 3, let me know.

V/R,

John
 
What unit are you in that lets you RSI? We cant even give otc nsaids in 1AD.
i worked the code for practice mostly but an off duty emt from my organization had made initial contact periarrest and we had some Texans helping. I know he cant be saved, but I did want to try.
 
Rocketmedic said:
What unit are you in that lets you RSI? We cant even give otc nsaids in 1AD.
i worked the code for practice mostly but an off duty emt from my organization had made initial contact periarrest and we had some Texans helping. I know he cant be saved, but I did want to try.
Click to expand...

Two words: organ donor.
 
Doczilla, do you ever think about the standard of living with these guys? Not having a dig at you, it sounds like a nasty call that you've done well with, but what happens when that L/N survives?

Case in point: One of our ANA callsigns takes x3 casualties from an IED strike. 2 Cat B and the poor bugger that detonated it was Cat A. R leg amputated at the knee, L Leg barely hanging on mid thigh and a badly smashed up right arm. He was extracted, MERT got him back to our Hospital at BASTION and he survived... As a triple amputee. In a country as poor as that, with little or no healthcare available, he's now a huge burden on his family. We had a chat with the ANA commander and the consensus was they could just about manage with one leg, but anything more than that and they'd want to be left to die... A payout for a dead son would help their families a lot more than a disability pension and having to care for him for the rest of his life.

Obviously in the real world we don't have to make these decisions, and as callous as it sounds, in Afghan I've had times when I felt relived that they've died.
 
Well, yeah you're right. This is one success story intermixed with several sad ones, as well. This one just happpened to turn out favorably, which may or may not have had to do with the care rendered. [Probably more thanks to the neurosurgeon who drilled the burr holes in his head.] This guy was ABP, so partner force enjoys some type of priority over regular L/N's. [As you probably are aware]

Not all of our encounters ended happily. The biggest victims here seem to be the kids, because the parents just don't give a crap. They let a kid "fall" into a bread oven and finally decide to take he/she to you when eschars develop; leaving you to deal with not only the primary life-threats, but also the secondary and tertiary effects as well [rhabdomyolysis, hyperkalemia, renal failure, hypoglycemia, airway swelling, etc]

To address the previous question, I can't exactly tell you the unit I'm in, but I will tell you that in our little "mud hut" of a little aid station we have quite the array of drugs and capabilities. For RSI, we have much to choose from, including Etomidate, Ketamine, Fentanyl, Versed, Propofol, Vecuronium, and Succynlcholine.

V/R,

John
 
I dealt with more of the 'door kicking' side of things, in the upper Gereshk area. We had PEDRO / MERT from Bastion within about 20 mins and a fairly decent Med Centre at MOB Robinson, even KAF was about 40 mins... but not a whole lot on the ground. We could deal with the trauma but for nearly everything else it was Aeromed to some where that could cope. And based on the types of casualties we had it worked well. Most of the L/N had left the area so leaving the PB was pretty much an advance to contact! Good times...
 
Way crazier than Iraq.
 
usafmedic45 said:
Two words: organ donor.
Click to expand...

What are the procurement regulations in your region? Around here live organs can't be used unless the donor is perfusing at time of recovery.
 
This patient was not a donor possibility.
 
Head trauma that severe as to cause cardiac arrest = DRT (dead right there).
 
You must log in or register to reply here.
Back
Top