Vomiting Blood During Full Arrest

BryanR said:
He wasn't even intubated! All we did was put in an OPA, bag him, and do compressions. At least the medic admitted that he had no clue. Most of them couldn't do that, what with their giant ego XD
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harold1981 said:
Indeed. What´s wrong with guys that see it as a sign of incompetency. No matter how experienced, you won´t always know, unless you are pretending to.
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The OP's from the greater LA County area, I believe. His bolded statement here implies they're operating the same way they were when I left with a "I-could-care-less" attitude because they got a late call, or are tired, or just plain don't care; probably all of the above.

There's absolutely nothing wrong with admitting you don't know, if anything it shows what you do, and ensures you're open to learning more, typically, but the way the majority (not all) of these fire medics at least in this county function goes a bit further than just saying I "don't know".

So I say no, chances are they don't know, and won't care to ever learn any better; that's a problem. They're probably pissed they're not on the engine that day anyhow. That's how it was when I was there, that's how it still appears from the encounters we have with them at their hospitals.
 
@VentMonkey I would imagine it'd be hard to get good ETT placement with lots of emesis. Under those circumstances, wouldn't BVM + BLS airway adjuncts be OK "for now"?
 
EpiEMS said:
@VentMonkey I would imagine it'd be hard to get good ETT placement with lots of emesis. Under those circumstances, wouldn't BVM + BLS airway adjuncts be OK "for now"?
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Possibly, sure. I'm not going to arm-chair QB the call, at least not without more insight from the OP.

I think this is a perfect candidate for a King, a 30-45 degree angle, and continuous suction once the King is placed, and adequate SPO2 is confirmed.
 
VentMonkey said:
Possibly, sure. I'm not going to arm-chair QB the call, at least not without more insight from the OP.

I think this is a perfect candidate for a King, a 30-45 degree angle, and continuous suction once the King is placed, and adequate SPO2 is confirmed.
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Yeah, I didn't think of an SGA - makes sense to me.
 
BryanR said:
So last night I had this full arrest. During transport...
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Why would you transport if no ROSC was achieved on scene? Was he hypothermic or did he go into cardiac arrest during transport?

One possibility for bleeding from trachea during resuscitation is that the distal airways and vessels collapse and a good quality CPR generates quite a strong thoraic vacuum which sucks variable amount of blood into the alveoli. We try to avoid that by keeping the alveoli open with a PEEP of around 5 cmH2O.
 
photog said:
Why would you transport if no ROSC was achieved on scene? Was he hypothermic or did he go into cardiac arrest during transport?

One possibility for bleeding from trachea during resuscitation is that the distal airways and vessels collapse and a good quality CPR generates quite a strong thoraic vacuum which sucks variable amount of blood into the alveoli. We try to avoid that by keeping the alveoli open with a PEEP of around 5 cmH2O.
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Seems like the vast majority of places are still transporting full arrests that do not get ROSC on scene. Sadly we are still required to transport all full arrests who have been in any rhythm that is not asystole or PEA <20
 
Protocol, man, that's why. It is a sad state of the world. Also it is hard to explain, in some cases - so that is a reason of debatable validity.


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Our protocols recently "updated" to include a 30 minute scene time for all arrests without ROSC in spite of the rhythm (asystole, PEA, VF/ VT without a pulse) after 30 minutes.

Honestly speaking? Not much different than what I have been taught over a decade plus of ACLS. It did seem like a lot of newer medics around here were doing a load and go approach recently, perhaps being egged on by fire (had a captain try that once with me, and my intern...that was funny).

Long story short, our current county medical director made it official. Again, my personal opinion is som people really need to be told what to do to-a-tee. With the exception of certain circumstances I plan on going about what I've been doing for pretty much every arrest I have had thus far.
 
Weve been given the go ahead to terminate efforts without medical direction at our discretion.

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GMCmedic said:
Weve been given the go ahead to terminate efforts without medical direction at our discretion.
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That too has been in our protocols since I've been here, I think even before. That said, aside from an obvious death, If I work it I'm typically pawning that off on "Doc Hazard", and "Nurse Crupp" for my documentation.
 
VentMonkey said:
That too has been in our protocols since I've been here, I think even before. That said, aside from an obvious death, If I work it I'm typically pawning that off on "Doc Hazard", and "Nurse Crupp" for my documentation.
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Really the only time I dont call is trauma codes. There are a few docs that will still have us work them only to call them within a couple minutes.


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