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

[usalsfyre]

As low of a chance as they have of coming back from that cardiac arrest, we're supposed to try no?

Nope. Futile, expensive and dangerous care is just that. Futile, expensive and dangerous. EMS has got to get away from the "try to save everyone" mentality.

 

[MrBrown]

As low of a chance as they have of coming back from that cardiac arrest, we're supposed to try no?

No, you said it mate, it is clinically futile and inappropriate to commence resuscitation on these people

The same can be said for somebody who is an unwitnessed arrest with asystole as initial rhythm or housebound dying from end stage cancer etc

 

[Lady_EMT]

</lurking>

Nope. Futile, expensive and dangerous care is just that. Futile, expensive and dangerous. EMS has got to get away from the "try to save everyone" mentality.

Unfortunately, due to many protocols around the country (my area included), CPR is to be started on EVERY patient, unless there are injuries incompatable with life, or lividity/rigor have set in. So if I have a pt such as the one in the OP, I am to start CPR, or else my toosh will be on a silver plater. Unless, of course, but "stuff," it meant brain matter (but that's covered under 'signs incompatible with life').

To the OP, I have a few kind words of advice.

1) On this forum, and in real life in general, remember to be very specific. People in real life and on this forum will chew you up and spit you out if you aren't to-the-dot specific. (Trust me, I know ) That isn't necessarily a bad thing, but if you want true and honest advice and support for these calls, you need to list everything just the way it is, as long as it doesn't violate HIPPA.

2) Unless you have a jump bag in your POV, don't stop. There's nothing you can do, except call 911. Especially since you didn't have anything, I would assume that would mean you didn't have gloves, and for a trauma, no gloves is a big No-No.

3) You had a blank moment. I'm going to pass on some advice to you that was given to me. This moment doesn't define you as an EMT. Many people in EMS will have a moment that makes them stop in their tracks. I agree with other people in that you didn't seem to do a proper size-up, and seemed to disregard scene-safety. But you jumped into a situation where you didn't have a partner by your side to help shake you from your freeze. Don't let this call define your career. And if you continue to have moments like this when you freeze up and can't function on your own, perhaps then you should reconsider another field.

If you ever want to talk one-on-one with anyone, there are plenty of open and welcome PM boxes, mine included. Don't lose sleep over this one. It happens.

 

[Sasha]

When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.

Bleeding control on a brain dead patient is equally futile.

Sent from LuLu using Tapatalk

 

[McGoo]

Unfortunately, due to many protocols around the country (my area included), CPR is to be started on EVERY patient, unless there are injuries incompatable with life, or lividity/rigor have set in.

I would class major blunt trauma combined with either PEA or asystole as incompatible with life. I wouldnt be surprised to find crepitus in the neck when moving the head to gain an airway either, which would make me think they have even less chance of living.

 

[usalsfyre]

Evidence of exsanguination would be another injury incompatible with life.

 

[Hunter]

Bleeding control on a brain dead patient is equally futile.

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"Idealy in real life you would wanna do both at the same time if possible"

 

[Sasha]

Ideally in real life, CPR comes first.

 

[jjesusfreak01]

Evidence of exsanguination would be another injury incompatible with life.

Usually. I've heard stories of esophageal variceal ruptures that looked like a horror scene with what was obviously multiple liters of blood around the patient. The medics were ready to call a DOA only to find the patient still had a pulse.

 

[usalsfyre]

Usually. I've heard stories of esophageal variceal ruptures that looked like a horror scene with what was obviously multiple liters of blood around the patient. The medics were ready to call a DOA only to find the patient still had a pulse.

Yep, key being "had a pulse". In a CPR situation it's not worth working.

Agree though that a varaciel rupture will make you redefine "exsangunating hemorrhage".

 

[JonTullos]

In the region where I did my clinical time, most traumatic cardiac arrest is not worked. Mainly that has to do with the fact that there's only about a 0.01% chance of a ROSC. Even if you get ROSC, it may not last, not to mention the quality of life concerns. Don't worry about it. Chances are the patient was dead and just didn't know it yet.

 

[usafmedic45]

Mainly that has to do with the fact that there's only about a 0.01% chance of a ROSC. Even if you get ROSC, it may not last, not to mention the quality of life concerns.

The ROSC rate is often about 1-2% actually and as for quality of life, I have two words for you: ORGAN DONOR.

 

[nmasi]

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.


That and if the police, fire and ems crews werent there to respond, then the scene was most definately not safe for a sole bls provider to be on scene immediately following an accident. He/she did not know the circumstances surrounding the incident. Was the patient deliberately hit in an attemted retaliation for drug violations, did they just finish robbing a bank and are attemtpting to escape?

Probably not a good idea to jump out and play Bobby Hero. Stay in your car and observe so as to give a good report if needed as a witness. Like most have said, blunt trauma arrest is a no bueno situation.

 

[jjesusfreak01]

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.

Man, I always forget about this because my textbook didn't cover it in the well-being chapter.

 

[dewey]

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.

___________________

Just started as a basic, and don't have a clue what this means. Little help please? Are you saying the scene itself was unsafe(in which case I understand), or are you saying that the PT him/herself could become dangerous due to a lack of BSI?

 

[Shishkabob]

It was a joke.

Hence "zombie"

 

[dewey]

Yeah I'm a moron. Thanks tho

 

[BlakeFabian]

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.

 

[EMT424]

Ivan,
At a scene where apparently no one was helping this guy, you stepped up That is commendable. He sounds as though the outcome was pretty certain. If this helps you to be more aggressive next time then it is for the good. You shouldn't use it as an excuse to beat up on yourself, the fact is that we cannot save everyone. We can do our best, but the Decider is elsewhere.

Went to a similar situation with an MVA. We got the kid restarted 3 times and he lasted long enough at the hospital for the family to say goodbye. It suck still.

You stepped up and tried and maybe gave the kid some sense of care and comfort as he left this world. That is worth something.

 

[mspazz]

When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.

I think you have "Focused Assessment" and "Rapid Assessment" confused here bud. ABC=Airway Breathing Circulation. In no way shape or form does "listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP" fall into that category. Those are a Focused Assessment. Rapid assessments are used for finding life threatening injuries and treating them ASAP.