Trauma arrest, should CPR be stopped in the field?

[Melclin]

we won..the pt is now severly disabled due to hypoxia, acidosis toxicity prior to our arrival, but he is alive....idc about his prognoises,

Doesn't sound like a win to me. Also sounds like the pt wasn't arrested on arrival, but arrested during treatment - thats a different ball game. Sounds like it was recent too, which means your may lose the war in the long run.

Resuscitating a person to the point of admission to the veggie patch is not a win in most people's book. In fact, given the incredible financial strain it puts on the healthcare system and the difficult to measure emotional cost for the family of the person who dribbles away in supported accom for a few months/years before they die of pneumonia, I would say this outcome is worse than death.

 

[Veneficus]

Doesn't sound like a win to me. Also sounds like the pt wasn't arrested on arrival, but arrested during treatment - thats a different ball game. Sounds like it was recent too, which means your may lose the war in the long run.

Resuscitating a person to the point of admission to the veggie patch is not a win in most people's book. In fact, given the incredible financial strain it puts on the Family and the difficult to measure emotional cost for the family of the person who dribbles away in supported accom for a few months/years before they die of pneumonia, I would say this outcome is worse than death.

Fixed that for you, US healthcare is a pay to play system.

 

[RocketMedic]

wow, i have read all the replys and im shocked...we are worried about the rights and wrong concerning protocols and forgetting greatly about patient care. as a medic i know the chances of survival for a traumatic arrest is very slim...its a very small chance, but there is still a chance. i have worked a coded pt in decom shock after a mci mva, we had a long extracation time so we called for a bird, and yes cpr in progress as fire broke the vehicle apart. as the bird arrived and fld bolus and numerous medications later, we manage to get the pt to v fib from asystole and shock the pt. we worked hard though science and our education said screw him, and we won..the pt is now severly disabled due to hypoxia, acidosis toxicity prior to our arrival, but he is alive....idc about his prognoises, i care about doing the my job to the best of my ability until our arrival at the appriopriate facility....dont get burnt out guys and treat everyone with dignity as we will like our family treated. leaving a pt in the ground because u dont want to tie down a rig is not a reason to put the family through that ordeal. nevertheless, rules are theire for a reason, we are not paragods, we are encourage to think on our feet in reguards to pt treatment, not to think of ways to bend rules toward patient care and of course our relation with their families.

As a total aside...dude, you need to work on your sentence structure. If your reports come through like this, you'd have QA/QI all over you, every shift.

 

[usalsfyre]

wow, i have read all the replys and im shocked...we are worried about the rights and wrong concerning protocols and forgetting greatly about patient care. as a medic i know the chances of survival for a traumatic arrest is very slim...its a very small chance, but there is still a chance. i have worked a coded pt in decom shock after a mci mva, we had a long extracation time so we called for a bird, and yes cpr in progress as fire broke the vehicle apart. as the bird arrived and fld bolus and numerous medications later, we manage to get the pt to v fib from asystole and shock the pt. we worked hard though science and our education said screw him, and we won..the pt is now severly disabled due to hypoxia, acidosis toxicity prior to our arrival, but he is alive....idc about his prognoises, i care about doing the my job to the best of my ability until our arrival at the appriopriate facility....dont get burnt out guys and treat everyone with dignity as we will like our family treated. leaving a pt in the ground because u dont want to tie down a rig is not a reason to put the family through that ordeal. nevertheless, rules are theire for a reason, we are not paragods, we are encourage to think on our feet in reguards to pt treatment, not to think of ways to bend rules toward patient care and of course our relation with their families.

Spend some time on the back end of this type of incident seeing the ICU stays, failed attempts at "rehab" and eventual admit to a SNF to be warehoused till death. You will likely reconsider your position.

 

[Rialaigh]

If anyone could comment on my last post (last page) as the thread seemed to have died out after I posted. I am just curious If I seem to be totally off base here or if I have at least a little bit of sense with that line of thinking.


Lets kick around Trauma arrests in general with head injuries and ETOH, I would think it would increase the odds that the person arrests from respiratory failure and not blood loss or irreversible organ damage. Obviously arrest due to respiratory failure is going to be something I would think we would want to work and a call with a much higher (not high, but higher) chance of a save with at least a decent prognosis.

 

[the_negro_puppy]

Paramedics in the U.S should have the ability to pronounce death without calling a physician, especially in the setting of trauma where reversible causes have been considered.

 

[Ace 227]

Spend some time on the back end of this type of incident seeing the ICU stays, failed attempts at "rehab" and eventual admit to a SNF to be warehoused till death. You will likely reconsider your position.

+1. As an EMT that runs both 911 and inter-facilities, I can certainly attest to the fact that after going in and out of too many SNFs to count, I will have a DNR the day I turn 65. There are fates worse than death

 

[Smash]

I know I shouldn't jump on the new person, but I just can't help it. Notwithstanding the issues with the case as posted by the OP:

we worked hard though science and our education said screw him, and we won.

No, you didn't. You may have worked hard, you may have drawn on your training (although if you did I would ask for your money back), but there was no science, or even common sense in: "fld bolus and numerous medications" in cardiac arrest from blunt trauma.

I am not aware of any credible sources that advocate that sort of approach to blunt traumatic arrest (I'm not talking about commotio cordis here). Cardiac arrest from blunt trauma, in the field, is fatal. It's not an arrest, it's a dead person. You can be a hero and throw everything but the kitchen sink at them. Sometimes you can even get a pulse back. But, as you found out, a pulse doesn't mean much on it's own.

said screw him, and we won..the pt is now severly disabled due to hypoxia, acidosis toxicity prior to our arrival, but he is alive....idc about his prognoises, i care about doing the my job to the best of my ability until our arrival at the appriopriate facility

If you don't care about prognosis, why bother? Poor prognosis, good prognosis: if it's all the same, save the time, energy and money and just don't start. Although you certainly did screw him I suppose.

....dont get burnt out guys and treat everyone with dignity as we will like our family treated. leaving a pt in the ground because u dont want to tie down a rig is not a reason to put the family through that ordeal

Is that the dignity associated with inflicting invasive, futile treatments on a corpse, or a different type of dignity? The ordeal of giving a family false hope, only to encumber them with catastrophic costs to care for a brain dead husk, potentially wrecking more lives due to the financial hardship they have been lumbered with?

 

[ExpatMedic0]

Cardiac arrest from blunt trauma, in the field, is fatal. It's not an arrest, it's a dead person.

agree

 

[MrJones]

Paramedics in the U.S should have the ability to pronounce death without calling a physician, especially in the setting of trauma where reversible causes have been considered.

I can't speak for the entire country, but paramedics in my state can pronounce death without calling a physician.

 

[marcus]

(idk if im posting this right but here it goes)

if the family become overwhelmed by financial obligations, that, doesnt concern me neither dooes the prognoises. why worry about things that i cant do Anything about, considering this is ALS, not long term care. i know the survival rate of a arrest from truama is less then one percent, my point is that; it is not zero. why not give every person that margin of fighting chance and not throw it away due cost and quality of life?

the bolus was due to penetrating truama that caused significant bleeding...you assumed it was for blunt trauma which overall is misleading as well cause there are some blunt trumas that do warrant fld boluses. perphaps you should use your own advice and use your common sense.

treating a corpse is a much better dignity then leaving him on the floor and giving him that less the one but not zero percent chance he deserves. its not false reassurance if you believe there is a chance. i would try to provide empathy and sympathy to every family member i encounter but patient care is my main concern. if i decide that there isnt much we can do, then i would refocus my attention towards tge family needs. after they are out of reach and out of sight, go see a therapist cause its not my problem, their mental statis or financial obligations when i finish the call. i believe ultimately is out of our hands but our job is to try. it would had been a easier way to just work and trassport. if he is meant to die he will reguardless of what we do.

I know I shouldn't jump on the new person, but I just can't help it. Notwithstanding the issues with the case as posted by the OP:



No, you didn't. You may have worked hard, you may have drawn on your training (although if you did I would ask for your money back), but there was no science, or even common sense in: "fld bolus and numerous medications" in cardiac arrest from blunt trauma.

I am not aware of any credible sources that advocate that sort of approach to blunt traumatic arrest (I'm not talking about commotio cordis here). Cardiac arrest from blunt trauma, in the field, is fatal. It's not an arrest, it's a dead person. You can be a hero and throw everything but the kitchen sink at them. Sometimes you can even get a pulse back. But, as you found out, a pulse doesn't mean much on it's own.



If you don't care about prognosis, why bother? Poor prognosis, good prognosis: if it's all the same, save the time, energy and money and just don't start. Although you certainly did screw him I suppose.



Is that the dignity associated with inflicting invasive, futile treatments on a corpse, or a different type of dignity? The ordeal of giving a family false hope, only to encumber them with catastrophic costs to care for a brain dead husk, potentially wrecking more lives due to the financial hardship they have been lumbered with?

 

[usalsfyre]

(idk if im posting this right but here it goes)

if the family become overwhelmed by financial obligations, that, doesnt concern me neither dooes the prognoises.

:blink:
How can you NOT be worried about these things? You talk about "saving lives" but never consider the long-term sequelae?

why worry about things that i cant do Anything about, considering this is ALS, not long term care.

Except if you don't start, you've prevented it.

i know the survival rate of a arrest from truama is less then one percent, my point is that; it is not zero. why not give every person that margin of fighting chance and not throw it away due cost and quality of life?

Have you ever been around LTC? Have you heard the term "fate worse than death"?

the bolus was due to penetrating truama that caused significant bleeding...you assumed it was for blunt trauma which overall is misleading as well cause there are some blunt trumas that do warrant fld boluses. perphaps you should use your own advice and use your common sense.

Common sense would dictate that you realize lost blood is lost blood and saline does a less than poor job of supporting perfusion.

treating a corpse is a much better dignity then leaving him on the floor and giving him that less the one but not zero percent chance he deserves.

Then why do most states have laws against mutilation of a body?

its not false reassurance if you believe there is a chance. i would try to provide empathy and sympathy to every family member i encounter but patient care is my main concern.

AHA has put a lot of energy in to educating about family support in an arrest...for a reason

if i decide that there isnt much we can do, then i would refocus my attention towards tge family needs. after they are out of reach and out of sight, go see a therapist cause its not my problem, their mental statis or financial obligations when i finish the call.

What an awesome care provider

i believe ultimately is out of our hands but our job is to try. it would had been a easier way to just work and trassport. if he is meant to die he will reguardless of what we do.

This post is an example of everything wrong with EMS in the United States, starting with the grammar.

 

[ExpatMedic0]

everything usalsfyre said... I concur

 

[Merck]

Sorry marcus but they're right. Not the best post and usalsfyre has summed it up nicely.

 

[Handsome Robb]

Marcus, get out of EMS now...that's the exact wrong attitude to have.

 

[rmabrey]

I have had Dr's tell me a refusal was fine only to have dispatch call me back and tell me to call the ER, where a new Dr tells me that refusal is not ok and I need to transport.

Maybe I am just oblivious to laws in other states, but this is kidnapping in Indiana.

 

[Epi-do]

Maybe I am just oblivious to laws in other states, but this is kidnapping in Indiana.

Remember that just because the doc advises you to transport, that doesn't mean you "have" to transport. The patient is still able to refuse to go. At that point you just document that the patient was advised of the risks, what you did to try to get them to go, why they refused, and that they are aware the doc advised them to be seen. Ultimately, as long as the patient is competent, it is his/her decision regardless of what the doc on the other end of the radio advises.

 

[Handsome Robb]

Remember that just because the doc advises you to transport, that doesn't mean you "have" to transport. The patient is still able to refuse to go. At that point you just document that the patient was advised of the risks, what you did to try to get them to go, why they refused, and that they are aware the doc advised them to be seen. Ultimately, as long as the patient is competent, it is his/her decision regardless of what the doc on the other end of the radio advises.

This is exactly why I don't call OLMD for AMAs... We have a few protocols that require it but haven't run into one yet. Mainly being a patient meeting trauma center criteria by physiologic components or injury or a STEMI patient.

 

[epipusher]

The post from marcus was not enough to warrant these responses. Who the hell are you to say he is what's wrong with ems when stating an opinion or belief. In addition, this is an internet forum, the grammar soapbox is not needed as well. Relax.


edit: edited for grammar

 

[Aidey]

Yes, it was. This is a bad place to profess out of date, close minded, uneducated opinions. Opinions are not sacred. Especially when your opinion is the exact opposite of what what science based medicine has shown. And Kyle didn't say he was everything that is wrong with EMS, Kyle said his post is everything that is wrong with EMS. Also, when communicating via writing spelling and grammar are important. Whether you like it or not, people judge each other by the quality of their writing. The better your English is, the more likely you will be taken seriously.