A Questions For The Medics

[usalsfyre]

Agree with what was said before, if you arrest in the wilderness your dead. No reason to even try CPR. I'll go a step further and say if you arrest more than 4-6 minutes from a defibrilator your probably dead, no matter how long that process may take.

[crotchitymedic1986]

Cut open his chest with your swiss army knife and do cardiac massage, he will be dead if you dont. But seriously, the epi dose IV (stick a vein dont do IM) couldnt hurt.

[chbare]

And in the wilderness scenario described, try a precordial thump. I believe it generates approximately 4 joules - about the same under dosing as the epi pen... Can't hurt, might help.

The AHA 2010 consensus regarding this is no. In an unwitnessed arrest, it is considered a class III intervention. Just to be clear, the joule is the SI unit of derived energy or work. Epinephrine is not a unit of energy or work. Energy may be used and or required when epinephrine changes the conformation of a beta or alpha receptor, but that is different than talking about an actual unit of energy.

Take care,

chbare.

[Kaisu]

The AHA 2010 consensus regarding this is no. In an unwitnessed arrest, it is considered a class III intervention. Just to be clear, the joule is the SI unit of derived energy or work. Epinephrine is not a unit of energy or work. Energy may be used and or required when epinephrine changes the conformation of a beta or alpha receptor, but that is different than talking about an actual unit of energy.

Take care,

chbare.

I didn't mean to imply that the energy correlates to the medication. I was just suggesting that the inadequacy of the dose of electricity(energy) is as inadequate as the dose of medication (epi).

And the precordial thump suggestion was tongue in cheek

[chbare]

My bad for misunderstanding your post. I'm a little dense at times.

Take care,

chbare.

[chbare]

*2

Edited April 23, 2011 by chbare

[Kaisu]

My bad for misunderstanding your post. I'm a little dense at times.

Take care,

chbare.

pshaw... my humor was obviously obscure... you are anything but dense.

cheers

Kaisu

[uglyEMT]

Thanks again everyone.

OK so the consensus is a NO on the Epi Pen. Kind of what I figured. Dust thanks for that explination about profusion and SQ. Didn't think of it that way. Glad your back

[NYCEMS9115]

Ok folks been offline a while but still been active. Increased work load, extra shifts, education. Last night was the first night off in a while and went to the local watering hole with some EMS buddies. Well while dicussing EMS in general a show came on (dont know what it was, just reading some of the CC) basically a survior show (not the show survivor but about a survivor). Two guys camping in the wilderness, one has a heart attack, one gives CPR for god knows how long and finally the guy comes back. Now being we were all Basics we were dicussing this and couldn't believe without defib, meds, or advanced care it was possible.

Anyways, my one buddy asked about Epi. Which got us wondering say you were in a wilderness setting, a long duration of time away from advanced medical support and had Epi pens (auto injector basic type .3mg) would .6mg be enough to help? OK before all hell breaks loose we are NOT talking our day to day settings here. We are talking wilderness survival settings where you are your only help for hours or days. You know those shoe string and a branch splint, might have to knaw the limb off to survive settings (OK extreme but after some Jack what else is to be expected).

In honesty I don't know what amounts of meds you all push during an arrest. What we were thinking is .3 or .6mg would be an improvment then nothing at all. Would there be benifit or harm?

Just a question we through out there and passed around along with the rounds.

Admin: if this is in the wrong forum feel free to move.

Epinepherine will not work via that route (IM/SQ). The person is dead; so the only way medications, nutrients, or oxygen will flow to the brain and other vital organs will be with adequate chest compressions. So, IV/IO will be the best and only acceptable route of administration. Even ET route has been eliminated. Nice show, concept is there but its not reality... All the best...

Sounds a bit like when John Travolta stabbed Uma Thurman with Epinephrine in the heart. While, Eric Stoltz and Rosana Arquette were watching. Without the heroin OD though...

Sorry for the late response... Good luck in your career...

Agree with what was said before, if you arrest in the wilderness your dead. No reason to even try CPR. I'll go a step further and say if you arrest more than 4-6 minutes from a defibrilator your probably dead, no matter how long that process may take.

I wouldn't say no CPR. AHA has determined that most people; healthcare providers included; can't detect a carotid pulse in an unresponsive patient. The Guidelines remain the same (even after the 2010 AHA ECC changes); to continue CPR even after defibrillation without checking for a pulse because the patient can be in such profound shock; CPR wouldn't hurt; it would help.

So, the DEAD wilderness person may not be DEAD; he may be in profound shock. Do CPR until help comes (hopefully you can get help), the patient is revived (if CPR revived them; then they were not DEAD; they were in profound shock), or you're too exhausted (not EMS exhausted; which can be misconstrued as laziness but physically exhausted)...

All the best...

Cut open his chest with your swiss army knife and do cardiac massage, he will be dead if you dont. But seriously, the epi dose IV (stick a vein dont do IM) couldnt hurt.

You gotta do what you gotta do. Its like when Julianna Margolies was on a break from the ER; she walked into a store and a man held up the store. Took money; something went wrong. Another patron was choking and she cut the dude's trachea and inserted the Crystal clear Bic pen in his windpipe. Save his life. She's such a GOOD WIFE...

you are out in the wilderness with a long way to go to get help? is that the scenario?

The person in arrest is dead. Simple as that.

Sure go ahead and give the epi but be prepared to explain the two needle marks to the medical examiner.

You will then after you realize that the epi didn't work, you will have to fashion a carry device to drag your friends body out of the woods. Or you could leave him and come back to him after you arrive to get assistance.

My thought's are, make it out to get a body recovery team.

The results of the scenario suck but sometimes it's what happens.

Good Samaritan Laws take in effect. You're not on duty; you weren't responding to the hikers location. You were one of the hikers.