How nurses handle emergencies!!

[Summit]

Pls correct me if I am wrong but in my readings I remember seeing something that said field arrest due to blunt trauma has the <1% number but arrest due to penetrating trauma had much higher save rates.

 

[jeepmedic]

This is why Emergency Physicians in LA have been outraged in EMS protocols. One physician has even spoke at numerous conventions and medical seminars, declaring ...."EMS is nothing more than a hearse with lights on it!".. The point being if the patient has no chance of survivability, the patient should be able to be declared dead on the scene. Period. There is nothing more in resuscitative measures a ER is going to perform or do that the field ALS/EMS has not already performed. So why transport and increase financial burden, decrease available beds ?

Hopefully, we will be seeing more and more declarations in the field. This will be either by no resuscitative efforts being started or field termination.

R/r 911

But the Emergency Physicians are the ones making the protocals. We write what we think should be done and they approve or disapprove them. So if they do not want us to try to save there life then rewrite the protocals.

 

[Ridryder911]

They are.. look at the new recommendations from ECC and ACS on cardiac and trauma resuscitation. Local politics apparently is preventing some advances.

Summit, you are right blunt has a higher morbidity.. but even with that saying penetrating ballistics of vital organs still have a high morbidity. The problem being is the usual "tumbling" of the projectile missile is likely to strike multiple areas. It is very rare to have a "clean" through and through.. albeit, it can happen. I would have to evaluate the location and case.. but chances are I still would declare traumatic arrest DRT (dead right there).

R/r 911

 

[Summit]

Summit, you are right blunt has a higher morbidity.. but even with that saying penetrating ballistics of vital organs still have a high morbidity. The problem being is the usual "tumbling" of the projectile missile is likely to strike multiple areas. It is very rare to have a "clean" through and through.. albeit, it can happen. I would have to evaluate the location and case.. but chances are I still would declare traumatic arrest DRT (dead right there).

R/r 911

I am familiar with wound profiles for various rounds at various ranges (I am a weapons enthusiast).

But I could have sworn that field arrests of penetrating trauma had much much higher save rates than from blunt trauma.

http://www.caep.ca/page.asp?id=BC71D7E2C2DF4126AFB049B34EC57144
indicates resuscitative thoracotomy penetrating trauma arrests prior to arrival in the ED have a 35% save rate (2 studies are quoted, also argues for no rescusitative thoracotomy on blunt arrests) although presumably they coded while enroute, not PTA EMS.

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-146
reported the opposite in regard to resuscitative thoracotomy finding a study with 0% discharge survival for penetrating arrests.

ok i only felt like opening 2 google hits since i've opened 2 beers

 

[TheDoll]

i thank you all so much for being patient with my question as well as taking the time to post your explanations. every time i think i know the answer to something i find i have a million questions to follow it up! anyways, you are all so kind not to make me feel like a nimrod! you know, i wish i could just buy a bottle of about 10 years of experience, but i have to put my time in just like everyone else!
again, thanks!

 

[Summit]

Doll, you asked a valid question with a good attitude.

When someone finds out how to sell bottles of 10 years of experience, they are gonna be rich... rich I tell you!

 

[Nycxice13]

What exactly do they expect us to do? If the patient is gone, no one can bring them back, period. Would they rather us not even try? Not exist? What?

To say we are driving hearses with lights on is ridiculous, Im sure there are a GREAT number of patients that have survived due to our efforts.

Just because you are a doctor, doesn't mean you know all or have great common sense.

 

[Ridryder911]

What they expect us to do is get involved in protocol development and demand to use new standards. Yes, do nothing (when it is appropriate). Traumatic deaths (especially crushing) do not live...Period

Cardiac arrests in aystole do not respond after the second level or round medications ... period. Therefore, protocols should be changed to new studies and research that has demonstrated such for the past 15 years and several thousands of patients.

To bring a patient in and then immediately cease the code, only causes false hopes in families, increase costs and actually should be considered unethical since we actually know it will be futile.

Medics should be active in their protocol development and be encouraging the medical director(s) or committees to change. This data and standards is not new, and should be changed as soon as possible and monitored.

R/r 911

 

[Stevo]

and do you know of any ems orginization that has, or is willing , to champion these grass root causes Ryder?

~S~

 

[Fedmedic]

That's pretty much how we handled it at my last agency. Traumatic arrest would automatically get bilateral decompression, secure the airway, two rounds of drugs, if no success, we confirmed DRT.

Medical arrest, if asystole-two rounds of drugs, if no change-confirm DRT.
Basically we didn't even load CPR's in the ambulance. We worked it until either they were dead and left them on the scene or we had a pulse. Not in protocol that way, just rule of thumb. We would call in to the medical control and tell them what we had done and that we had d/c'd efforts and they were cool with it.

 

[Ridryder911]

and do you know of any ems orginization that has, or is willing , to champion these grass root causes Ryder?

~S~

Sure American Heart Association has published several articles including discussion of not starting resuscitation in the Healthcare Providers BLS book and ACLS as well. National trauma courses such as PHTLS, ITLS and ATLS both endorse and teach the likelihood of traumatic arrest (crushing) of being terminal or fatal.

Other organizations such as American College of Surgeons (ACS), Emergency Nursing Association (ENA), all have published standards and guidelines as well.

Again, this is really old standards that have been around greater than 10 yrs.

One of the services I worked for performed field termination even in the late 80's.

R/r 911

 

[Stevo]

imho, it would be a big step for the powers that be to hand us the holy water, but i would welcome it.

~S~

 

[jeepmedic]

Now for the answer "How nurses handle emergencies?"


They Call 911 to get a Paramedic.

 

[medic03]

akflightmedic wrote: ....As a flilght medic, we do not respond to nor do we transport traumatic arrests unless they happen to code after we have picked them up......

Yep, it amazes me every time we are about to land at the LZ or a few min out and they say, " Tell the medic that we are doing CPR...." and I get on the radio and tell them to go by ground. Only if I fly someone off the beach will I pick up an arrest due to there being no streets that lead to a hospital. From some points where we cover you need a ferry to get you back to the main land or marine PD will take you by boat.

 

[firecoins]

in 1996 when I was 18 and in the middle EMT class I came upon a bad head on collision. I "worked" the car accident telling adults 2x my age what to do including an RN. RN didn't seem to really know what to do in an emergency but she obviously knew more about general medicine. She just did what I told her to do.

The medics who I worked with told me a story of an RN who did CPR on a patient who conscious.