Working a code alone in the back?

[MSDeltaFlt]

If I am working in the ED, I love to hear the Thumper coming in if I don't want to start up a ventilator for the ICU. I have not seen many success stories come out of its use over the past 20+ years. I have seen it thump a lot of different parts of the body besides the sternum.

The Autopulse is just hitting our area so I can not say much about it from personal experience.

That's funny.

"Where'd this pt get his black eye from?"

"Beats the hell out of me doc, but you oughta see this new contraption. It's cool."

But in all serirousness, at the service I work part time, we've had a few issues with some medics and pronouncing cariac arrests. Therefore, our protocol has been changed to work a fresh code for 20 min on scene, then call Med Control, and they will advise. Sometimes you'll be transporting that dead person 30 miles all the way to the hospital. Usually you won't, but sometimes you will.

It's times like that when the service needs a contract with Gatorade to have some waiting for the crew after the call. Damn, that's exhausting.

[Mateo_1387]

HA HA...nice thought Matty...

Have you ever seen a thumper??? Anyways, no I would never put one on cause of a maybe.

Autopulse I can not speak intelligently of, as I have very limited experience with one.

I have however attached the pads from the monitor as a "just in case".

LOL, I just went to youtube and looked both up. Yea, I could just see someone putting on the thumper, that would be too funny. "no ma'am, you won't feel a thing...." I am sure there is someone out there that has done it though, hahaha.

I think the autopulse would probably fit better if you thought your patient was about to code. I have heard of people applying the pads for patients they thought would become unstable.

[JakeEMTP]

I think the autopulse would probably fit better if you thought your patient was about to code. I have heard of people applying the pads for patients they thought would become unstable.

I have never applied the Autopulse if I thought someone perhaps may code en route to the ED. Considering that the transport times for us are generally < 15 min, I'll start compressions if I have too. If we have a patient that is truly that sick, we'll have a FF drive ( They're ALWAYS willing) and my partner and I will ride in with the patient.

Now, I have applied pads to the patient and had the intubation kit ready. :-$

[Mateo_1387]

I have never applied the Autopulse if I thought someone perhaps may code en route to the ED. Considering that the transport times for us are generally < 15 min, I'll start compressions if I have too. If we have a patient that is truly that sick, we'll have a FF drive ( They're ALWAYS willing) and my partner and I will ride in with the patient.

Now, I have applied pads to the patient and had the intubation kit ready. :-$

Jake, we do the same thing if we are lucky. Over where I live if you are out in the country and have a critical patient you just go, getting the FD out there would be a miracle in some places. Hopefully as paramedics we can keep our patient stable during transport.

I am curious, you are willing to apply pads and have the intubation kit ready, why not the autopulse? I have never had the pleasure of even seeing the autopulse, so entertain me as to why you did not apply it in those instances you applied pads and readied the intubation kit.

[JakeEMTP]

I am curious, you are willing to apply pads and have the intubation kit ready, why not the autopulse? I have never had the pleasure of even seeing the autopulse, so entertain me as to why you did not apply it in those instances you applied pads and readied the intubation kit.

Quite frankly, I never really considered it. I can only ASSume that the Autopulse would be extremely uncomfortable for the patient. The fact remains though, we don't transport patients who have coded. That being said, I have had patients code en route. That's when I would begin compressions. I suppose in theory I could place it on them. I would think though it may make the patient more anxious than they already are.

Yeah, we have a pretty good relationship with the FD. You are correct though, once we are out in the country, we are on are own.

[Mateo_1387]

Makes sense to me. I have no experience with it, that is why I asked. Only one place I work for transports codes. It should be a thing of the past IMHO.

[Asysin2leads]

Do the best you can and generally doc understand you were alone if you don't get something done. But if you are transporting always remember the ABC's. Drugs don't do much good if the blood ain't going round and round. The good old saying; "air goes in and out blood goes round and round. Any variation of this is bad fix it."

I have a saying too. Its called one person CPR, in the back of the ambulance, is almost completely ineffective, and serves only to increase risk of injury to the providers and give false hope to the family.

[EMS49393]

When I first became an EMT-A, we had thumpers on our ambulances. I think I put it together a total of five times. Back then, we didn't have the luxury of working the code and calling the Doc for a termination.

Now, we're talking about 15 years ago, not nearly as long as some here have worked, but long enough to know the difference between ACLS then, and ACLS now. I've recerted ACLS several times. The first few times, it was challenging. The megacode was something the paramedic feared, and you felt like you ran a race when you completed it. The last ACLS class I attended was so easy a caveman could have passed it.

Here is irony, back when ACLS meant something, you couldn't terminate a code if your own life depended on it. Today, with the paramedic puppy mills putting all their little pups out there with some half-arsed, ridiculously easy ACLS class, a good number of services are able to call med control to terminate. Including mine. Funnily enough, I'm the only paramedic at my service that works a code, calls med control, and gets orders for termination. I hear other medics running that stuff in to the ER all the time. I just shake my head and hope that a deaf family of four with a vision impaired father doesn't pull out in front of this speeding ambulance and meet an untimely death. An untimely death over a person that is dead. Ugh, it gets me fired up.

A side note about the thumper. I would recert my CPR every year with the same rat pack I worked with. We were rebels, not to mention bored senseless (thank God when it changed to a 2 year card), and we were known to create disturbances in class to keep us entertained. Our favorite antic for years was to mimic the sound of the thumper, quietly, under our breath. At least we knew how to have a good time.

[ffemtp1988]

Wow! I had forgotten all about the old oxygen powered thumpers. The service I worked for back in the late 80's early 90's had two of them. Back then you would get a supervisor response on an arrest just to bring you the thumper. You would work it alone then the supervisor would pick it up at the hospital. The ED's hated them because the just didn't understand them, but they worked.

[mshow00]

I hate to ask a stupid question, but ROSC is not a term I am familiar with, what does it mean? Return Of Spontaneous Circulation?