Would You Work This Code?

[Dustdevil]

...but overall, who knows

That's exactly why you have to work it.

If you don't, you're going to end up being just another one of the medics who we constantly see on the news, being decertified, fired, and sued for abandoning a trauma patient who the ME later finds to have a rhythm. Even though they usually die, the public is going to say, "but who knows?"

Don't be a lazy arse. And don't be a protocol monkey. Your education has apparently been inadequate to explain to you the finer points of differentiation to the "we don't code trauma" rules. And that excuse isn't going to save you when you screw up.

Edited May 16, 2009 by Dustdevil

[CBEMT]

And as you are extrapolating, how much do you think the family of the dead patient across town that could have been saved if resources had not been expended on a hopeless case were not tied up working the hopeless case?

I can't treat a patient I don't have yet. It's a dispatcher's job to send them a truck. I have a patient in front of me. This is the one I treat, or don't, based on THIS PATIENT. Not some imaginary one across town.

[HERBIE1]

How much do you think they will appreciate the enormous bill for transport, rescusitation efforts, ED room, etc. etc. for what was clearly a doomed effort ? And as you are extrapolating, how much do you think the family of the dead patient across town that could have been saved if resources had not been expended on a hopeless case were not tied up working the hopeless case?

With that rationale, and the same reasons you cited, then why resuscitate anyone over the age of, say 75? After all, they probably only have a couple more good years left anyway.

[FireMedic65]

Yes I would work it. CPR was already started and I am the next higher level of care and it's my duty to continue.

[Kaisu]

OK - so to take this discussion back to the question I believe the OP was looking for clarification on, let me try to summarize:

In a case of traumatic arrest, in this specific situation only, (in the interests of getting the answer narrowed down a little) lets assume that this is traumatic arrest - in other words, you as the provider, and in our scope of practice, it IS our duty to pronounce, have determined that there is little to support non-trauma causes for the arrest, the consensus appears to be if 1 - immediate CPR and 2 - down time of approximately 10 minutes ( when you arrive as a transport unit medic)

If the rhythm is asystole, you would pronounce

If the rhythm is PEA, you would work it

Now assuming that is PEA and not CPR artifact (I know I know.. but it happens a lot)

Some other questions?

What rate of PEA?

Would you decide otherwise if the rate is 20 vs say, 65?

PS.. thanks to all who are contributing - it is an important discussion.

[HERBIE1]

OK - so to take this discussion back to the question I believe the OP was looking for clarification on, let me try to summarize:

In a case of traumatic arrest, in this specific situation only, (in the interests of getting the answer narrowed down a little) lets assume that this is traumatic arrest - in other words, you as the provider, and in our scope of practice, it IS our duty to pronounce, have determined that there is little to support non-trauma causes for the arrest, the consensus appears to be if 1 - immediate CPR and 2 - down time of approximately 10 minutes ( when you arrive as a transport unit medic)

If the rhythm is asystole, you would pronounce

If the rhythm is PEA, you would work it

Now assuming that is PEA and not CPR artifact (I know I know.. but it happens a lot)

Some other questions?

What rate of PEA?

Would you decide otherwise if the rate is 20 vs say, 65?

PS.. thanks to all who are contributing - it is an important discussion.

Time frames are irrelevant. According to whom has the person been down for 1, 5, 10 or 15 minutes? You need to use your own judgment and follow protocols.

[p3medic]

I believe I'm more or less in the same thought process of Croaker. If its PEA, rule out correctable causes, i.e. tension PTX, tamponade, perhaps fluid challenge. This patient went from 70 to 0 in very short order, T-boned a car at that speed on a motorcycle. I know that where I work, the only question that the surgeon wants to know is if there was signs of life on EMS arrival. If the answer is "no", and we haven't found a readily correctible injury, the patient gets called. There is no indication for thoracotomy or the use of large amount of blood products in trying to resucitate a blunt trauma arrest, at least in these parts.

[Kaisu]

Time frames are irrelevant. According to whom has the person been down for 1, 5, 10 or 15 minutes? You need to use your own judgment and follow protocols.

Time frame is NOT irrelevant. A 20 or 30 minute down time with no improvement is important for determining cessation of efforts. In our area, just because we start working something does not mean that we don't decide to stop working it.

[tniuqs]

That's exactly why you have to work it.

If you don't, you're going to end up being just another one of the medics who we constantly see on the news, being decertified, fired, and sued for abandoning a trauma patient who the ME later finds to have a rhythm. Even though they usually die, the public is going to say, "but who knows?"

Don't be a lazy arse. And don't be a protocol monkey. Your education has apparently been inadequate to explain to you the finer points of differentiation to the "we don't code trauma" rules. And that excuse isn't going to save you when you screw up.

You gotta work it. If you haven't seen such a patient pull out of it, you haven't been in the field long enough yet.

Agreed !

ER DOC

PEA=work it

asystole=DRT

You have to consider/treat the potential causes of the PEA.

It is beginning to become apparent that the "Dinozzo Headslap" is ineffective as an educational technique, Look again to the OP ... this is all second hand information and an extremely poor presentation of a scenario ... I heard, I was told ... I am smarter than my Field Medic .... good grief.

Now Duty to call Dead ? ... ahem is that in a protocol somewhere and I missed it ?

[Kaisu]

Agreed !

It is beginning to become apparent that the "Dinozzo Headslap" is ineffective as an educational technique, Look again to the OP ... this is all second hand information and an extremely poor presentation of a scenario ... I heard, I was told ... I am smarter than my Field Medic .... good grief.

Now Duty to call Dead ? ... ahem is that in a protocol somewhere and I missed it ?

The original poster is an EMT. He/She is not questioning his/her medic. He/She is trying to learn something and has asked this forum to help him/her. In the process, a very good discussion has ensued.

Field cessation of effort, as well as declaring dead is within the protocol of our paramedics.