Would You Work This Code?

[NCFD18]

Blunt trauma arrest have very low chance of resuscitation. Also you will get alot of flack for bringing something like this into the ED. However I would work the code. I usually will work a code if the bystanders started CPR, and if the Fire dept is still continuing the code. This a courtesy code definitely.

[tired-medic]

From what is presented here I would have worked this code.

You have CPR early, everything points to a workable code under all protocols i have used over the years. The likelihood of success seems low to me due to PEA not being resolved in the field. Just my 2 cents.

[Mparham02]

If the pt has a palpable pulse then he is not in PEA.

If the cause of the cardiac arrest is trauma and there is no visible cause that can be quickly corrected in the field there is nothing that is going to be able to be done for this person at the hospital. I am sorry but dead is dead, and is not fixable. I would not work the code.

[PLJones]

I would work the code for a couple of reasons...

I realize that there isnt much to do to actually resuscitate the guy when looking at the MOI, but you can work him to let the bystanders know you're gonna try. Alot of times an occasion like this will be the only encounter a person has with an EMS system until they need it themselves...they want to know you are going to do everything you can to help them.

Second reason, and i dont know if this has been stated yet or not, is if the guy is an organ donor. Alot of times you can preserve the organs by keeping blood flowing through and 02 coming in. Now obviously there's no way to find out if the organs are still viable in the field (unless they're spilled out on the ground...its easy then) so every pump of blood and molecule of oxygen you send through will be able to get to those organs, keep them viable and be able to help someone else who needs them.

These are just the 2 things i think of when i read the initial post...sorry if its a reposting of someone else's thoughts, i didnt read through the entire thread.

[ncmedic309]

Good, cause that's what I was referring to as well. A cardiac arrest secondary to blunt force trauma that's in VF. I'd consider it almost criminal to see that rhythm and not shock it, when you had a chance to save that person's life.

What outcome are you expecting with this intervention? If the patient has suffered a VFIB arrest secondary to a traumatic event, do you really expect to get ROSC after defibrillation. If the arrest is secondary to trauma, it's not cardiac in nature. We can't fix that with electricity, we can't fix that with ACLS medicatioins - there is no point in performing these useless interventions, it's been proven time and time again. It's likely that we can get a change in rhythm, likely PEA or asystole after defibrillation, but then what? There's nothing criminal about it, it's based on factual medicine and it's standing orders directly from our medical director. It's not something he just came up or decided to go with, everything in medicine is evidence based as is our standing orders for blunt traumatic arrest.

Why would you not make an attempt on anybody in VFIB when you suspect the arrest has a blunt trauma etiology?

Because death secondary to trauma is DEAD. I've been doing this job for well over 9 years and I've seen a ton of arrests both medical and traumatic in etiology. You can work the crap out of a traumatic arrest, load them up with fluids and cardiac drugs and eventually achieve ROSC. Does it sustain itself? I've never seen it last for long, every single blunt trauma arrest I've had in my career has the end result of death. If it makes you feel better, do it - it's your call to make. You can call me burned out, a horrible medic, whatever you like, I don't give two shits. I do what I do based on my knowledge and experience. I truly feel that I make the best decisions possible for each and everyone of my patients, even the ones that are beyond my reach. When and if you get to the point where you can make these same decisions on a daily basis as a medic, maybe you'll stop being so naive and see how things really work. I wish the best of luck to you, there's nothing easy or pleasant about it.

[tniuqs]

Funny thing in even ACLS it states to treat possible underlying reasons for PEA or V Fib, AGAIN with the information initially provided one can not "RULE OUT" another reason, go back ... READ.

And bounce this off "standing orders" from your MD ... I bet ca$h he will tell you to work ALL PEA or even asystolic arrests for a minimum of 45 minutes and all ACLS interventions have been attempted with resources available and anything else is just lazy or worse ... I can hear it now ... "the book said" ---- Your Honour.

It's not something he just came up or decided to go with, everything in medicine is evidence based as is our standing orders for blunt traumatic arrest.

Wrong ... where do the 2% that do survive so fit into your "research data" and don't just quote ACLS "EMS mother of all book's" there is much evidence "factually" that disagrees with your statement and if we continue to adopt that idea we will fail many just think 1% of 2000 is (do the math)

Because death secondary to trauma is DEAD

Relying on stanch so called evidence based medicine "concepts" that you quote and EMS will continue to propagate ignorance. By the way we used to use 2 amps of Bicarb in an unwitnessed arrest too ... we were actually using a coup de grau ... forgive my French, how will we know anything if we adopt this attitude ... like really.

For there ARE those that do survive a traumatic arrest, someone in these cases did not quit based on the 30 before and the rational thought process that your claiming.

maybe you'll stop being so naive and see how things really work

Oddly enough I have personally needled "bilateral" chest in a PEA and guess what, yup the guys 72 y/o now !

pfft kinda makes your blatant statements appear (again fill in the blank)

Quoting:

You can call me burned out, a horrible medic, whatever you like, I don't give two shits.

No thanks but your words speak for themselves.

[ncmedic309]

Funny thing in even ACLS it states to treat possible underlying reasons for PEA or V Fib, AGAIN with the information initially provided one can not "RULE OUT" another reason, go back ... READ.

I've already READ the entire thread, we've already discussed this, I'm not going back to it AGAIN...

And bounce this off "standing orders" from your MD ... I bet ca$h he will tell you to work ALL PEA or even asystolic arrests for a minimum of 45 minutes and all ACLS interventions have been attempted with resources available and anything else is just lazy or worse ... I can hear it now ... "the book said" ---- Your Honour.

How much do you want to bet? I'm game, you name the amount. It's my call on whether or not the arrest gets worked, regardless if it's medical or trauma. I'll throw this at you though, let's change the scenario - MEDICAL ARREST with you name the rhythm. The only thing I have to do if I decide to work it is perform ACLS measures for 20 minutes and with no ROSC and low EtCO2 readings the game is over. In that time frame, they've got an airway, vascular access and at least two rounds of ACLS drugs on board. What more do we need to prove at that point?

The rest of your post isn't even worth taking the time to quote or respond to - if someone can give me something worthwhile I'll gladly respond - otherwise I'm done with this thread...

[AnthonyM83]

What outcome are you expecting with this intervention? If the patient has suffered a VFIB arrest secondary to a traumatic event, do you really expect to get ROSC after defibrillation. If the arrest is secondary to trauma, it's not cardiac in nature. We can't fix that with electricity, we can't fix that with ACLS medicatioins - there is no point in performing these useless interventions, it's been proven time and time again. It's likely that we can get a change in rhythm, likely PEA or asystole after defibrillation, but then what?

I'm expecting a certain number to go into asystole from the defibrillation, but at least a certain number to end up in with an actual pulse. Direct trauma to the chest can send a heart into VFib. If there's not significant damage to the heart, some energy is sometimes all it needs to reset itself. Rule out commotio cordis (survival stats around 15%).

Yes, some may lose pulses again, but that's common in medical etiologies as well. And far all you know, it could be an underlying medical. Not asking you to transport and put lives at risk, but in a risk vs. benefit analysis, don't see why you wouldn't shock VF. Blunt chest trauma VF can survive, too. Sucks for the few who are given up on because a round of ACLS was too much.

[primemedic01]

In my opinion, I would not have worked this code, first off its a trauma code so that to me is red flag number one, second is the PEA,yes it can be converted into a better rhythm but overall, who knows, third is how the patient was presenting so again, nope; tell the family some BS story of how we tried yada yada yada but overall its a no go.

I hope the family of someone you "tried to save yada yada yada" reads this post and you "lose your job yada yada yada" and "lose your license yada yada yada" and you "are forced to never work in EMS again yada yada yada."

This is a public forum, and however unlikely, the possibility of a family member who has lost someone close to them and is seeking more information as to what happened and how EMS handles these types of situations could easily do a google search and find this post.

And you people wonder why no one takes us seriously..

[medic15401]

But why waste the resources on someone who will obviously not survive (or is not meant to survive)? At that moment, your skills/resources could be needed across town for someone who will survive - but only if you are available with intact resources.

I frequently work with patients who are 'survivers' of some massive blunt force multisystem trauma accident. In order for them to 'continue' in life, they now breath through a hole in their neck, 'eat' baby formula through a tube in their stomach wall, pee and poop like babies, have open sores on their butts because of peeing and pooping like babies, are dependent on others to clean their pee and poop, to put Desitin on their open sores caused by the pee and poop and must have the the drool wiped off their chin. And this is the result of someone giving them a 'fighting chance.' Some injuries are meant to be survived.

Remember, a bed sore killed Superman (Christopher Reeves).

Are you a God? Are you Superman? Are you an RN?

I hope you are good at all of these because with a statement like that you are probably not a good medic.