This is bothering me

All QA needs to do is take a leap of faith... a quantum leap of faith.
 
Cannot argue against the value of having an ECG of asystole 2+ leads however...

It doesn't have the be the hard fast rule to pronouncing, it seems more like a "monkey step" for EMS systems who don't quite trust the abilities of their Paramedics. It is misleading however... just because you have asystole doesn't mean you can negate the other steps to assessment.

Did you attempt to open the airway (perhaps there was rigor noted?)? Document!
Did you auscultate breath sounds in 2+ bilat positions for longer than 60 seconds (ambient temp is huge factor!)? Document!
Did you palpate the carotid for periods longer than 60 seconds (ambient temp is again important!)? Document!
Did you auscultate heart sounds? Document!
Did you pay any mind to the condition of the skin (color/temp/cond, lividity, cyanosis, SYSTEMIC putrefaction, rigor at major joints, etc [ambient temp considered again!])? Document!
Did you assess pupils (particularly their response/unresponsiveness)? Document!

A nice strip of asystole in 2+ leads is a great tool, but writing a PCR that says "pt was found dead, here is strip, left pt dead with police" is pitiful... and we've seen those during CQI!
 
Chelle said:
We have a 3 lead heart monitor that we have been trained to use and run a strip from. All of our B's use it. Does this mean we aren't supposed to be? I'm new enough that I've only used it once, and that's the machine I should have said instead of the AED.
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This doesn't sound good. Who all are you supposed to run strips on with this monitor? Just DOSs, or other patients too? And what are you supposed to do if you get something other than a flatline? I can't think of any good reason for doing this.
 
And yet another......

Arizona Victim Thought Dead, Not

The Sun, Yuma

http://www.emsresponder.com/article/article.jsp?id=9608&siteSection=1


May 28--The 20-year-old Yuma man who was involved in a weekend automobile accident has died in a Phoenix hospital.

It has also been revealed that the accident victim, Jacob Schlamann, was presumed dead at the scene and left untreated for about an hour in the wreckage of the pickup he was driving.
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http://www.emsresponder.com/article/article.jsp?id=9608&siteSection=1

Initially Schlamann was pronounced dead at the scene, according to Erfert, and the wreckage of the vehicle was covered with a red tarp, which is the standard procedure when someone is killed.

Erfert did not specify how the paramedics checked Schlamann's condition, but said they generally check for vital signs.

A medical examiner, who had been called to the scene, detected signs of life in Schlamann and firefighters extricated him from the vehicle, according to Erfert.
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OK, so I have to ask... what if the person is so dead that they are getting...gooey. I wouldn't want to be putting stickers on and taking them off of /that/.

(Maybe it's different in other areas, but around here the SOP for finding a rotting relative seems to be to call for an ambulance, not the funeral home or police.)
 
Kookaburra said:
OK, so I have to ask... what if the person is so dead that they are getting...gooey. I wouldn't want to be putting stickers on and taking them off of /that/.
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That happens occasionally here in Florida with the hot sun making a person get rather gooey. It also happens very quickly before the heart has had a chance to stop so we find some patients in very bad shape but alive. You have to get over your fear of gooey stuff and get close enough to confirm death. I carry extra stethoscope diaphragm covers for these situations.

http://www.stethoscope.com/index.cfm?event=ProductDetail&ProductID=86
 
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PEA is close to asystole? PEA indicated electrical activity, Asystole is the absence of electrical activity.

Also, I was answering your question as to what "What would "sings of life" constitute as?" On the monitor.. anything but asystole is signs of life.
 
HotelCo said:
PEA is close to asystole? PEA indicated electrical activity, Asystole is the absence of electrical activity.

Also, I was answering your question as to what "What would "sings of life" constitute as?" On the monitor.. anything but asystole is signs of life.
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I know the difference between PEA and asystole. I also know what signs of life on the EKG turn out as.


Just making the inference that you're still pretty screwed with PEA.
 
Linuss said:
I know the difference between PEA and asystole. I also know what signs of life on the EKG turn out as.


Just making the inference that you're still pretty screwed with PEA.
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How so?

10chars
 
Mods, can you edit in:



And pulseless is never good.
 
VentMedic said:
That happens occasionally here in Florida with the hot sun making a person get rather gooey. It also happens very quickly before the heart has had a chance to stop so we find some patients in very bad shape but alive. You have to get over your fear of gooey stuff and get close enough to confirm death. I carry extra stethoscope diaphragm covers for these situations.

http://www.stethoscope.com/index.cfm?event=ProductDetail&ProductID=86
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Oh, I'm not scared of decomposing bodies - it just seems kind of unsanitary if you put stickers on and end up taking some skin with you when you take them off. Or would you leave the stickers in that case?
 
HotelCo said:
You can still have a better chance of survival, depending on what is causing the PEA.
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Still pretty screwed as it still has a pretty crappy survival rate, which is what I was getting at.


Never good when your heart stops beating.
 
Linuss said:
You re-use the leads?
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No but I'm confused because others were talking about putting them on, then taking them off. I was taught that we had to leave all equipment in place for the ME. And wouldn't the ME not like bits of skin missing from the corpse?

I really am curious, as I'm not going to be looking for paid work until after I'm out of medic school. I just tend to try to think through all eventualities (yes, yes, I know that's not possible) so I don't have to make things up on the fly when I'm out in the field.
 
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