Would You Have Called It?

[MedicPrincess]

The medic I had working with me yesterday and I had a small disagreement with the medic from FD about calling this code. Opinions?

47 y/o M, father states they had an early lunch and he was going to take a shower before going to work. Approximately 10 minutes later dad hears a loud "thud" followed by 2 or 3 other thuds. He calls for his son, no answer. Bathroom door is locked, after a minute or so he breaks the door in and finds his son unresponsive, shower still running. He is laying on the floor of the tub, with his head against the water spout.

FD is first on scene. They pull the patient from the tub and begin CPR. Asystole on the monitor. We arrive approximately 4 minutes after dispatch.

There is excellent CPR being performed. Great compressions. Two person BVM, however no OPA at this point. FD Medic is setting up for intubation. Theres enough people on scene we are able to change out the person doing compressions every 2 minutes. Unable to get a tube after a few attempts, went to LMA. LMA in place.

Drugs in... Vasopressin, Atropine, Epi.

BLGL, 195mg/dL

No change in condition, Asystole.

My medic asked me how I felt about calling Medical Control to see about calling it. I agreed, it appeared to be traumatic in nature and by this time his approximate down time was 35 minutes. We'd only be transporting so the ER Dr could call it, and that could be accomplished through Med Control. Fire Medic disagreed due to there being no medical history. He felt we should transport and continue resusitation efforts enroute.

We called Medical Control. MD advised to try Narcan. We did, it didn't work. DOA.

 

[Jon]

it appeared to be traumatic in nature

Princess - What makes you say that? Were there any visible injuries?

If there weren't any visible injuries, you get into the chicken and the egg arguement... did he go into arrest and then fall, or did he slip and whack his head/break his neck?


That being said - If they were asystolic from the get-go, and haven't responded to several rounds of drugs, they are probably dead. Even if you do somehow get a pulse back (high-dose epi, anyone) they will be brain-dead.

Finially - if FD beat you in, and you were there 4 minutes after dispatch - you guys did your best for "Early CPR" "Early Defibrilation" and "Early Advanced Care"

I think many of my medics would have done the same thing.

 

[DT4EMS]

Acutally the trend now will be to look more to calling asystolic codes sooner.

Survival rates from asystole are essentially zero.

Was the patient 47 or was that the age of the dad?

Regardless it's asystole.................

I would have called it too.

 

[Ridryder911]

Hmm... I don't like aystole, but I don't know where the term "traumatic" came from if it was in a house... did he shoot himself? . Traumatic is referred to injuries causing arrest, so what type of injuries ?

Now, was anyone suspecting overdose or other mechanism of injury or PMHX? I wonder why one so young would be in aystole so fast?..

Difficult case... probably call after discussing with a physician.

R/r 911

 

[MedicPrincess]

We were thinking possible slip and fall in the shower, broken neck. First person to attempt the tube couldn't see anything for all the blood.

OD was also suspected, but nothing turned up in the house. No prescriptions as all.

 

[DT4EMS]

Look for opiate type...........

Several of the "dead" opiate OD's from Oxycontin have had a bunch of blood in both the mouth and nose.

The blood in the mouth could have come from the original slip in the shower hitting the mouth, of the patient biting his tongue secondary to a sz.

Broken neck in the bathtub would be rare to say the least.

Let us know if you hear anything.

 

[Airwaygoddess]

That is a hard call, if anything, how old was the kid? what is your protocal for possible organ donation? maybe the patient being so young maybe the fire folks were thinking about that. What is the protocal for medical control to call the code in the field?

 

[FFEMT1764]

Well, I would have called it too. First, asystole after 20 minutes is not likely to change, ever, no matter the underlying cause. Secondly, it could have been traumatic, yes, from the fall, as it happens around here ever month or so that someone falls from a standing position, whacks their noodle on the way down, gives themselves a huge sub arachnoid bleed, and the heart just stops. And the broken neck thing isnt that far fetched either. As for the narcan, it doesnt hurt to give narcan to everyone who is unresponsive or in arrest.
Now what caused all the blood to be in the airway, thats the interesting part. Maybe a PE, maybe he blew out a ventricle, esophageal varicies also come to mind. But once all is said and done if ALs on scene within 4 minutes of the call you did everything you could, and as it stands most ER docs wont continue ACLS in the ED without VF or VT being present.

 

[BloodNGlory02]

The answer is going to differ from place to place, but if he was still warm, we have to work 'em regardless of rhythm. Not likely its going to be a save, but it's our protocol (for now anyways). We wouldnt be on scene 20 min with asystole to determine DOA either.