PNB

[Phridae]

Originally posted by PArescueEMT@Feb 5 2005, 09:49 PM
For Safety Pro:


.......A
....E....P
..S........P
....U....L
.......A

I don't understand that.

 

[Chimpie]

Originally posted by Phridae+Feb 6 2005, 07:21 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (Phridae @ Feb 6 2005, 07:21 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-PArescueEMT@Feb 5 2005, 09:49 PM
For Safety Pro:


.......A
....E....P
..S........P
....U....L
.......A

I don't understand that. [/b][/quote]
Round of applause.

 

[Jon]

Originally posted by Chimpie+Feb 6 2005, 10:31 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (Chimpie @ Feb 6 2005, 10:31 AM)</td></tr><tr><td id='QUOTE'>

Originally posted by Phridae@Feb 6 2005, 07:21 AM
<!--QuoteBegin-PArescueEMT

@Feb 5 2005, 09:49 PM
For Safety Pro:


.......A
....E....P
..S........P
....U....L
.......A

I don't understand that.

Round of applause. [/b][/quote]
Wa Whaaaa.....

 

[Jon]

Originally posted by SafetyPro@Feb 5 2005, 07:02 PM
As BLS, we're only allowed to "determine" death based on a few obvious factors, including PM lividity and rigor, and he didn't have any of the criteria. And barring any legal DNR/Advanced Medical Directive, we can't NOT start resuscitative efforts. So, we start CPR and hook up the AED. AED shows asystole. We continue with another cycle and again, asystole, so we package and go. Get him to the ER and they work him for a couple minutes before calling him.

are you allowed to call Command and elevate the decision above your head?

In PA for DNR's you call command anyway - the doc has the final say.

Sounds like you could have given the command doc the brief heads up and had him speak to the wife, explain the situtation, and let the doc decide, then the ED can't complain when you get there.


Hindsight is always 20/20

Jon

 

[PArescueEMT]

Originally posted by MedicStudentJon+Feb 6 2005, 12:36 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Feb 6 2005, 12:36 PM)</td></tr><tr><td id='QUOTE'>

Originally posted by Chimpie@Feb 6 2005, 10:31 AM

Originally posted by Phridae@Feb 6 2005, 07:21 AM
<!--QuoteBegin-PArescueEMT

@Feb 5 2005, 09:49 PM
For Safety Pro:


.......A
....E....P
..S........P
....U....L
.......A

I don't understand that.

Round of applause.

Wa Whaaaa..... [/b][/quote]
you would have done it if I hadn't and you know it.

 

[PArescueEMT]

Plus... it was a good idea.

 

[Jon]

Originally posted by PArescueEMT+Feb 6 2005, 05:42 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (PArescueEMT @ Feb 6 2005, 05:42 PM)</td></tr><tr><td id='QUOTE'>

Originally posted by MedicStudentJon@Feb 6 2005, 12:36 PM

Originally posted by Chimpie@Feb 6 2005, 10:31 AM

Originally posted by Phridae@Feb 6 2005, 07:21 AM
<!--QuoteBegin-PArescueEMT

@Feb 5 2005, 09:49 PM
For Safety Pro:


.......A
....E....P
..S........P
....U....L
.......A

I don't understand that.

Round of applause.

Wa Whaaaa.....

you would have done it if I hadn't and you know it. [/b][/quote]
it all depends on the meaing of the word "It" but probably yes


Jon

 

[Phridae]

Anyways....I just found out that the guy died on friday. Darn. Was hoping to chalk another one up for our walking codes.

 

[SafetyPro2]

Originally posted by MedicStudentJon@Feb 6 2005, 09:39 AM
are you allowed to call Command and elevate the decision above your head?

In PA for DNR's you call command anyway - the doc has the final say.

Sounds like you could have given the command doc the brief heads up and had him speak to the wife, explain the situtation, and let the doc decide, then the ED can't complain when you get there.


Hindsight is always 20/20

Jon

Nope, only Paramedics get to make base station contact here. EMTs just get to provide treatment based on our scope, which in this case is AED, CPR and high-flow diesel. Our rigs aren't even equipped with the radio system to make base station contact. All we do is call the ER on the cell phone once we're in route to give them a heads up of what we're bringing, and that's strictly a courtesy thing.

Now, had we had ALS on-scene for this call, then yes, they probably would have made base station contact, explained the situation and the base station staff would have made a field pronouncement. Since we're only BLS though, we're stuck with our protocol. We couldn't even call for ALS at that time because our transport time to the hospital is shorter than the response time for an ALS unit, and we're not allowed to wait on-scene for ALS to arrive. Long story, but we don't get an automatic ALS dispatch here...we're currently working on a way to provide ALS through out department.

If we have a valid DNR (state form or an advanced healthcare directive), we don't start (or if its in progress, discontinue) resuscitative efforts and hand off "custody" to the police until the Coroner arrives. However, any familiy member on-scene can override a valid DNR. In other words, if the wife says "Help my husband." we have to start resuscitative efforts even if he has advanced directives to the contrary.

We can "determine" a few specific obvious signs of death. Is a patient is pulseless and apneic and has one of these conditions, we don't start resuscitative efforts. Most of them are pretty obvious (decapitation, incineration, decomp, evisceration of heart, lung or brain tissue). The trickier ones are post-mortem lividity and rigor. In those cases, we have to auscultate breath sounds for 60 seconds, auscultate an apical pulse for 30 seconds and check for neuro-motor response (usually pupils).

 

[SafetyPro2]

Just got home from my second pulseless and apneic, terminal PT in 3 days. 180 degrees from the last one. This PT had a valid DNR and had the signs of death for a field determination. And the cop on-scene couldn't have been nicer (this one's one of the senior guys and head of their union).

Almost was three PNB calls...call earlier tonight for a seizure almost went bad. Just as I was walking in, the Capt. came out and told me "He stopped breathing...go assist with CPR." I rushed in, but he had spontaneously re-started, so we loaded him and transported.

God I'll be glad when this shift ends.

 

[Jon]

Originally posted by SafetyPro@Feb 8 2005, 06:00 AM
Just got home from my second pulseless and apneic, terminal PT in 3 days. 180 degrees from the last one. This PT had a valid DNR and had the signs of death for a field determination. And the cop on-scene couldn't have been nicer (this one's one of the senior guys and head of their union).

Almost was three PNB calls...call earlier tonight for a seizure almost went bad. Just as I was walking in, the Capt. came out and told me "He stopped breathing...go assist with CPR." I rushed in, but he had spontaneously re-started, so we loaded him and transported.

God I'll be glad when this shift ends.

I had one yesterday in clinical. The Doc's didn't answere the command phone, so EMS showed up with a "VERIFIED POA states Pt. DNR" - POA couldn't find DNR papers. if the Doc hand answered the phone, we probably wouldn't have gotten the patient.

I got to do CPR for the first time in 5 months - forgot how sore you are later....

Jon