Your patient arrests as you pull up to the ER

[akroeze]

So you're just pulling around the corner to the ER and your patient arrests on you. What do you do? Do you run the full code in the back? Do you shock once and then 'rolling CPR' into the resus room? Somewhere in between?

I can see arguments for both extremes in this one and really don't know what I would elect to do.

[aussiephil]

While the patient is on your bed, they are your responsibility.

Your action will depend on your local Protocol. That is CPR first or Defibrillation first.

If, as you say you are just pulling up, then i would take the first steps. If this is an ALS type call initially (if the patient is that sick one would assume ALS is treating), then the pt should be cannulated & airway managed. But what are the rescus guidelines? This will, as I said be your guiding force. It is also far more appropriate to be running a code in an ER than in an ambulance.

Besides, get em inside & then we can continue to claim no one dies in an ambulance, only on scene or in hospital. & also if you watch TV they have a better survival rate in hospital, i mean on ER they have about a 90% survival rate!!!!! :twisted: :twisted: :twisted:

[Camulos]

What sort of arrest? Shockable rhythm or not?

Stay safe,

Curse :evil:

[Timmy]

If you rocked up at my hospital your still running the show lol. You'd be lucky if two RNs came to help, we only allocate one emergency trained nurse to A&E on any one shift and maybe the student nurse will tag along. It will take around 10 to 15 mins for the doc to arrive after you call them as there only on call and even then there only General Practitioners with a 2 day ALS course. Your nearest bigger hospital is a 40 min bells and whistles drive down a long, dry, boring highway with no town in between. HEMS is 40mins fly time and that's if the closest chopper is available.

So, help your self pretty much. It's only 10 meters from the ambo bay to the recus bed. Tube, push meds, defib – knock your self out, chances are you know more than the doc that's about to show up.

[akroeze]

Here are some thoughts I'll throw out there:

Working them in the back means they will get care sooner (defib, drugs, etc) and will have continuous effective CPR. Down side is you don't have as many hands to do things.

Working them in the ER means they will have more resources available to them (more staff) which theoretically would be of benefit however to get them to the resus bed requires rolling CPR which we all know is about as good as no CPR at all and you have to plan on 45-60 seconds MINIMUM from time of taking them out of your truck to on resus bed with proper CPR being done.

[akroeze]

What sort of arrest? Shockable rhythm or not?

Stay safe,

Curse :evil:

Either, I want to know what people's thoughts are on various arrest scenarios.

[aussiephil]

What sort of arrest? Shockable rhythm or not?

Stay safe,

Curse :evil:

What difference does it make?

An arrest is an arrest, is an arrest.

you still need to bounce on the chest at some point. So what difference does it make if the rhythm is shockable or not?

[Camulos]

What difference does it make?

An arrest is an arrest, is an arrest.

you still need to bounce on the chest at some point. So what difference does it make if the rhythm is shockable or not?

Well for me it makes a HUGE difference. Even the presenting rhythm can make a HUGE difference to my decisions here. I can outline numerous different arrest situations where the clinical condition would alter my approach. That is for later though. For the moment I must assume that you have a stock standard approach you would apply in EVERY arrest scenario. As such I would appreciate if you could answer the question - Do you stop the ambulance and treat or do you continue on?

As you obviously believe arrest management is so generic this answer must apply to ALL arrest scenarios. Once you answer I'll give you some scenarios and we will examine whether your ONE approach is applicable in every situation. After all as you state "An arrest is an arrest". :roll:

Eagerly awaiting your answer. But I suspect you may have already changed your mind and won't give me ONE. If you do answer though keep this in mind "Tis the prettiest little parlor that ever you may spy."

Let the back pedalling begin!!

Stay safe,

Curse :evil:

[BushyFromOz]

So close to hospital i would be inclined do CPR and have my offsider pass a message to comms to notify the hospital. Id do CPR and assisted vents as we park the truck, shock if its shockable and then wheel the 14 odd meters into the resus bay.

Anything more than 3/4 or more minutes i think id be inclined to pull over and work on the side of the road waiting for a back up car.

this is assuming its your bog standard VF arrest, tension pneuma decompression or getting fluid/adrenaline in for a PEA would necessitate pulling over for a minute.

[ncmedic309]

I've been there before and it always sucks! I make sure we have the basics covered and then move the patient into the ED. I make sure we have at least a good BLS airway with an adjunct and BVM and we are effectively ventilating the patient, make sure we are able to perform chest compressions, have the monitor attached to the patient with pads so we can manage any rhythm disturbances as needed and move the patient into the ED.

The last one we did, the initial call-in via radio painted the picture of a rapidly declining patient but still alive. The patient coded as we pulled into the ED and we rolled inside doing CPR and ventilating the patient. We stopped in front of the triage desk to get our room assignment and a quick reassessment revealed VFIB. After yelling "CLEAR" multiple times and defibrillating the patient in front of the triage desk, we had everyones attention and our room assignment. 8)

I just feel that if your at the ED and can move the patient inside providing you have the needed assistance to do so, it's your better course of action. You have more room to work, more hands to help you work and a few more things that we don't have the pleasure of using in the back of the ambulance. I don't see much benefit to the patient sitting outside the doors of the ED and working an arrest.