Penetrating traumatic arrest, work or not?

My typical scenario is a bit different, in that we have short response times and we're never very far from a Level I trauma center. That said, as a general rule, we'll transport a penetrating trauma arrest and pronounce a blunt trauma arrest.

Our resuscitation efforts for trauma are limited- CPR, IV access, airway management, needle thoracostomy if indicated. We won't defibrillate and we won't use any ACLS drugs.

We actually had a patient a couple years ago who was in cardiac arrest from multiple gunshot wounds to the chest. He had a total of about 45 minutes without a pulse (response+scene time+transport+ED time) and survived with a good neurological outcome.
 
TransportJockey said:
Ugh the pea is what would force us to work it. Work it on scene and then call it. There is zero point in transporting it.
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This... only because of the PEA per protocol, and if that deteriorates I am calling it.
 
LACoGurneyjockey said:
You have a mid 30s male with multiple gsw's to the chest. Pulseless and apneic, showing a wide complex PEA at a rate of 30 on the monitor, fixed pupils. Call time was 15 minutes ago but bystanders can't advise any details on pt condition prior to arrival. Who out there would work it, who would pronounce? What are the protocols for everyone's system? For the sake of the scenario, you're 5-10 minutes from a small ER with no specialties, and 40 minutes from a trauma center.
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Small ER with no specialty back up? Does it even have an EM trained physician working? Would that EM trained physician even think of cracking the chest? Without known time of arrest, I think it would be reasonable to load and go - do needle decompressions, CPR, and intubate if possible (all en route). ED may not do much more than bilateral chest tubes. But I think if you are at all going to work it, you need to transport. Pronouncing on scene immediately is not unreasonable either.
 
ER is hit and miss with EM trained physicians. Sometimes it's a family practice physician, sometimes it's a doc with over a decade of level 1 trauma center experience. This night it happened to be the former.
 
I wouldn't have hooked the monitor up...

The only caveat to this scenario is how public the scene was. If we have a big crowd, we are supposed to work it.
 
DEmedic said:
What? Is that a written policy?
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I'm paraphrasing slightly, but we are not to terminate resuscitation in public places and there are times where, unless there is obvious death that can be identified by a layperson from a distance, resuscitation attempts may be "safer" for the crew so as to avoid upheaval.

I don't work in a nice area, if that context helps..
 
FiremanMike said:
I'm paraphrasing slightly, but we are not to terminate resuscitation in public places and there are times where, unless there is obvious death that can be identified by a layperson from a distance, resuscitation attempts may be "safer" for the crew so as to avoid upheaval.

I don't work in a nice area, if that context helps..
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Translating, they think if you don't work futile codes, someone is gonna shoot you?
 
I'd rather those "violent crowd" scenarios be handled as the situation merits on an individual basis, but I understand the thinking. I'm grateful I don't work in that kind of area.


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Our local protocol is that if it's not obvious 5-step CPR, and the body is still warm, you work it.
 
I would imagine 2 steps would be enough, but I guess you can never be too sure.
 
ThePants said:
It's when a vital part of the body, like a head, is detached from the body. Five footsteps from the chest to the head.

In other words, an MOI that is incompatible with life.
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Huh, never heard that before.
 
Summit said:
Translating, they think if you don't work futile codes, someone is gonna shoot you?
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There is certainly the risk of immediate violence on scene, emotions beget yelling and screaming which can and does escalate into distraction of property and life.

There's also the risk of people running their mouths to the media about what we should have or could have done. If the current climate is any indication of what type of society we're currently in, this event could be career ending and potentially lead to criminal charges thanks to the court of public opinion...
 
Do you live in Flint? Because I work in a pretty nasty area with high rates of violence and homicide, and I've never felt in danger for calling an arrest. They're usually just grateful we tried, even if emotions are high.
 
Same here. Inner city of a very large metropolitan city. Never felt personally threatened though, even on scenes where tensions are high.
 
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