I hesitated. And this guy might've lost his life..

[Melclin]

I find it extremely disturbing that nobody has brought up the fact that the OP obviously ignored the fact that there was the distinct posibility that the patient was in the transition to zombification and was in direct threat to his safety.

We have had recent guidelines introduced due to the threat of zombie apocalypse. We now have pick axes in the drug bag in between the morphine and glucose paste.

We wanted shot guns but the peer reviewed evidence suggested that there was an unacceptable chance of under kill as well as a very real chance of not looking cool while you wasted the mother f**ker. So our medical committee didn't approve it.

 

[dudemanguy]

I have what may be a stupid question here, but youll have to excuse me as I just volunteer as a first responder and have only worked one cardiac arrest.

Is there any time when you see agonal respirations that you wouldnt automatically begin Compressions? What if the patient had a pulse(the OP didnt state what he got when he checked for a pulse), would you still automatically flip the patient over and begin compressions due to the respirations?

Is it the case that the totally inadequate respirations automatically mean the heart is not pumping good enough and compressions are therefore warranted regardless of whether a pulse is felt? I mean with no equipment its not like you could do anything to assist with respirations unless youre gonna do mouth to mouth, right?

 

[Handsome Robb]

No. If they have a pulse they don't get CPR. Unless its a lil' guy and the pulse is less than 60.

If they are hypoxic chest compressions aren't going to help fix it, assisted respirations and O2 are. The heart is a muscle, it needs oxygen and glucose to function just like every other part of your body.

 

[dudemanguy]

Thanks NVrob, Whether or not I did compressions would have depended on whether or not I felt a pulse, agonal respirations or not. I was worried maybe CPR guidelines have changed or maybe people with more field experience knew something I didnt.

 

[Handsome Robb]

Biggest change in CPR is CAB instead of ABC, also no look listen feel.

Your welcome.

 

[Underoath87]

You did nothing wrong. Yes, you could of done CPR but in all reality it probably wouldnt of helped. If the guy died; It was from the accident, not from you.

In our service, a traumatic arrest resuscitation like that wouldnt even be initated. Our protocols says to give them a body bag & wait for morque personell to show. The survival rate of traumatic arrest is ungodly low.

Quick grammar lesson if you don't mind:
the word you're looking for is "have", not "of". It only sounds like "of" when spoken because we're using a contraction to form "could've" instead of "could have".

 

[mycrofft]

I had one like that once.

Motor cycle rider versus guy wire holding up a utility pole.
The second they turned him over his airway shut and he clinically died. He was dead when he hit that cable, but his side-lying position let the blood CSF and oral secretions flow to the dirt. This is what crash investigators call a "non-recoverable situation".

Tore the cable off it's anchor, he did.

 

[BrushBunny91]

No. If they have a pulse they don't get CPR. Unless its a lil' guy and the pulse is less than 60.

If they are hypoxic chest compressions aren't going to help fix it, assisted respirations and O2 are. The heart is a muscle, it needs oxygen and glucose to function just like every other part of your body.

Can someone explain why a child or infant might receive CPR in a pulse less than 60? My understanding is assisted ventilations bvm with supplemental oxygen and rapid transport would be within my protocols. At least until they reach respiratory arrest and then we would start compressions.

 

[JPINFV]

If they are hypoxic chest compressions aren't going to help fix it, assisted respirations and O2 are.

Not according to the good Dr. Conrad Murray.

The heart is a muscle, it needs oxygen and glucose to function just like every other part of your body.

Actually a healthy heart prefers fatty acids over carbohydrates. There's also the creatine kinase shuttle that helps supply energy substrates to cardiac tissue.

 

[Handsome Robb]

JP you cheat, your in med school!

Brushbunny, why would respiratory arrest warrant chest compressions?

 

[mycrofft]

ARC says compress the chest in resp arrest

In collapsed adults, most resp arrest, other than obvious airway embarrassment, is either caused by or rapidly leads to cardiac "arrest" (insensible and ineffective circulation).
Not to say that airway clearance should not be attempted if they are still conscious and indicate they are choking, or ventilations done for people promptly pulled from a pool.
Next iteration we will go back to the 1950's chest compression/arm lift for resuscitation.:glare:

 

[BrushBunny91]

Sorry guys I meant cardiac arrest

 

[dudemanguy]

BrushBunny91

Can someone explain why a child or infant might receive CPR in a pulse less than 60? My understanding is assisted ventilations bvm with supplemental oxygen and rapid transport would be within my protocols. At least until they reach respiratory arrest and then we would start compressions.

A normal Pulse rate for an infant would be around 120 or therebouts, depending on how old they are. The logic is that if its less than 60 AND there are obvious signs of inadequate perfusion despite adequate ventilations, then compressions would be warranted. This is per the AHA, If your protocols differ then follow your protocols.

 

[Yarbo]

There was a situation similiar to that around here in Canada somewhere. Crew found an infant with a pulse although slow, didn't start CPR and the infant died. All the details I know..

 

[CritiqueMyCalls]

Jumping in here from page six, I can easily see myself running this "call". I run up on scene, and stare at the patient numbly until EMS and PD arrive. As soon as they take control of the scene, I facepalm and wonder why I just stood there cluelessly.

There's a lot of up-in-the air things about the scene, but at least being able to describe what injuries the patient had would be good. At best, I would have considered starting CPR. I wouldn't have considered a trauma assessment, even if the PT was sitting up talking with me.

Take away? If you have no idea what to do, at least figure out what you can tell to the people that do. If that involves touching the patient, that's ok.

 

[BrushBunny91]

Jumping in here from page six, I can easily see myself running this "call". I run up on scene, and stare at the patient numbly until EMS and PD arrive. As soon as they take control of the scene, I facepalm and wonder why I just stood there cluelessly.

There's a lot of up-in-the air things about the scene, but at least being able to describe what injuries the patient had would be good. At best, I would have considered starting CPR. I wouldn't have considered a trauma assessment, even if the PT was sitting up talking with me.

Take away? If you have no idea what to do, at least figure out what you can tell to the people that do. If that involves touching the patient, that's ok.

Necromancer!

 

[paradoqs]

Where I am from, cpr comes before head to toe, vitals after (aside from abc vitals). And emt's always work arrests unless there is a medic there to pronounce or there are injuries incompatible with life. And blood and "stuff" on the ground is not one, unless that stuff is brain matter.

 

[mrswicknick]

Some of the comments here bother me. First, it is your legal duty to act when you witness an emergency. Not only that, but if you're not going to try and help someone when you have the proper skills to do so, why are you in this field. Even if the chance is so low for survival on that pt, anything and everything should be done to help so long as the scene is safe and you're pt is decapitated. I am not talking specifically about this case, but in general. What if the pt has a life threat that you could change or at least help until better care arrives and you just sit in your car or worse drive away?

Also, just because a pt is a blunt trauma arrest you're not going to even attempt to work him? Medics may have their reasoning, so this isn't directed towards them, but rather basics. I was first on scene, off duty, from a 3 story fall. Agonal resps, no pulse, but I started working him anyways. Medics arrived, did their job and the pt lives to this day to tell his story. It may be that I am new and haven't been on the job enough to lose hope, but even if 99% don't survive, how do you know that your pt isn't the 1% that does?

To the OP, the best thing I can say is my old instructors motto. "We didn't create the problem, we're just here to help." Like many have said, its a learning experience so that next time you will know what to do. 180 hours is not enough to give us any sort of muscle memory, and nowhere near enough to teach you how to stay calm and focused in what seems to be one of your first true emergencies. As someone else stated earlier, 1 call in real life is equal to 10 in class. Don't beat yourself up, you at least tried and that is all that matters.

I know I am new to this forum, and with only a little under 200 calls under my belt new as a basic as well. This is strictly my opinion and not a personal attack on anyone. I wrote this strictly so others can see a different light on the situation, and maybe to inspire those who said they wouldn't respond to think for another second the next time they're caught in a similar situation. I would hope that if I was hit by a motorcycle and had even the slightest chance for survival that one of you would work me through the ground as I would do the same for any of you.

 

[Tigger]

Some of the comments here bother me. First, it is your legal duty to act when you witness an emergency. Not only that, but if you're not going to try and help someone when you have the proper skills to do so, why are you in this field. Even if the chance is so low for survival on that pt, anything and everything should be done to help so long as the scene is safe and you're pt is decapitated. I am not talking specifically about this case, but in general. What if the pt has a life threat that you could change or at least help until better care arrives and you just sit in your car or worse drive away?

It is not my legal duty to act when I witness an emergency if I am off-duty. In fact, such laws are exceedingly rare in the United States, though I cannot find the specific statue for Washington state. Suffice to say it is certainly not the norm, and I am not legally required to render aid in either state that I live in.

I am in this field because I am interested in medicine and do in fact enjoy helping others. That doesn't mean I have to help everyone that I come across though. Sure I have the skills and knowledge (maybe), but if I injure myself or get myself sued, I'm not going to be able to work and that's going to affect my own personal wellbeing. Gotta look out for numero uno. And before you ask, I have stopped to help when off-duty, and will continue to do so when I feel that I will be able to make a difference while not placing myself in undue danger.

Also, just because a pt is a blunt trauma arrest you're not going to even attempt to work him? Medics may have their reasoning, so this isn't directed towards them, but rather basics. I was first on scene, off duty, from a 3 story fall. Agonal resps, no pulse, but I started working him anyways. Medics arrived, did their job and the pt lives to this day to tell his story. It may be that I am new and haven't been on the job enough to lose hope, but even if 99% don't survive, how do you know that your pt isn't the 1% that does?

Congrats, you got a save. Seriously, that's awesome that you helped save a life. But at the same time can you honestly tell me that guy is alive because you stopped to help? I don't think so...

Also, if a medic is not going to start resuscitation efforts, there is no reason to for a basic to start them either. Sorry but I don't understand that reasoning at all. I know what a traumatic arrest looks like too.

 

[mrswicknick]

It is not my legal duty to act when I witness an emergency if I am off-duty. In fact, such laws are exceedingly rare in the United States, though I cannot find the specific statue for Washington state. Suffice to say it is certainly not the norm, and I am not legally required to render aid in either state that I live in.

Congrats, you got a save. Seriously, that's awesome that you helped save a life. But at the same time can you honestly tell me that guy is alive because you stopped to help? I don't think so...

First, as far as how I was taught, it is always your legal duty to act, both on and off duty. If you have any sources that say otherwise then I retract that statement. Also, read "as long as the scene is safe." I am not suggesting anyone should go into any scene where you could be injured. And as long as you stay within your protocols and act appropriately to the situation, you're not going to lose your job.

Second, it took between 7-10 min before EMS arrived on scene on that call. If CPR hadn't been initiated immediately as it was, he would be dead. Given I actually witnessed the fall so in other cases where you have no idea how long its been, I could see your point and I should have clarified further.

Third, at least under my protocols, we will work anyone that isn't showing obvious signs of death. Again, what hurt is it to work someone at least until ALS tells you to stop? What if they are that 1%? If they aren't, its not like they're not going to get any dead-er. We as basics don't have the knowledge to rule out anything but obvious death, and even if you do, you cant unless you really want to get sued.