20 y/o Male Ejected

[QIKFire]

Hello forum, I am a BLS provider for a rural fire department. I had the following call recently and wanted to see some different opinions on what you may have done. We responded to a high speed MVC with an ejection and had a 20 min response time. A little more than 5 minutes out DPS arrived on scene and reported a 20 y/o ejected, unresponsive with weak pulses. The PT was pulseless upon our arrival and immediately started compressions and airway management. The PT had major facial trauma and a blood filled airway, suctioning was a constant task. Paramedics arrived 2 minutes later and applied pads. The monitor showed agonal PEA. Several attempts were made for an IV while compressions continued. About ten minutes in IV access was obtained but the DNR orders had already been received. - I realize a lot of info is left out but I didn't want to write a book... Is this a lost cause or called too soon?

[Katiebug]

There's about a one in one thousand chance of bringing back a traumatic arrest. Some protocols give the option of not working them at all.

If you're asking if more should have been done by the medics? I don't know. Wasn't there. Was there tracheal deviation? Lung sounds? Skull depression? Posturing? Pupils? Can basics combitube where you are? Too much info missing.

I'm fairly certain that if the medics thought it was workable, they would have worked it.

My opinion is based on information given only. Without the whole story, opinions don't mean much.

Edited July 23, 2011 by Katiebug

[BushyFromOz]

Out of curiosity, does your fire truck not have a defib?

[Katiebug]

And this is another case for an IO drill in every protocol. That way your not screwing around trying to get an IV for ten minutes when there's probably more pertinent issues at hand.

Again, my humble opinion.

[QIKFire]

Sorry about the minimal information I just didn't know how much pertinent information would be needed to get a response and I was trying to keep my opinions out. I know that trauma code ROSCs are slim to none. I have been on many and most are called on scene. This was a 20 y/o male who was unconscious with weak pulses prior our arrival. His facial bones were floating and had persistent blood draining into the airway (coming from the roof of his mouth ). There were no other signs of trauma to be noted. We do carry an AED. My partner and I were the first to that PT and I immediately started compressions as he cleared the airway. The Ambulance was pulling up as this process was initiated which is why I opted for their Lifepack instead of my AED. I continued continuous compressions and my partner continued constant suctioning (CCR protocol). The Medics applied the pads and saw PEA and I went back to compressions. The medic began to attempt IV access (Arrest protocol is IO). Meanwhile a flight crew arrives and asked to check the rhythm. The nurse took over the airway and dropped an OPA and attempted to bag. CPR was stopped for longer and longer periods until the PEA rhythm went to asystole. Epi was never given, advanced airways never considered, compressions were stopped for long periods and several strips were printed to get "timing" right.

Now I know that this pretty much a lost cause but... I was expecting work this kid hard and get at least a round of drugs in him, pump them around a bit, maybe even secure an airway and see what happens and then make a call. I would consider a reversible cause of hypoxia due to the blood blocking his airway. But once again there still was little to no chance but if there is any chance shouldn't we be giving our best effort to at least see if something changes that indicates he is part of the .03%?

- I by no means am saying that anyone was wrong or write but I fig I would just ask for other opinions to maybe see a different perspective.

[Kiwiology]

The only treatment this bloke is getting from me is a sheet put over him

[celticcare]

The only treatment this bloke is getting from me is a sheet put over him

Yeah but Ben, this guy had weak pulses on scene, a pulse is a pulse none the less. I know without seeing the patient I can't make a judgement call, unless there was brain matter splattered, I would have probably looked at maybe a round with some drugs and in this case, wouldn't the IO be utilised for the patient seeing as it was an arrest then at that point, or does it have to be VF/VT arrest? Just curious as I personally feel Io's are underutilised.

Without being there, like I said, I can't make a judgement call on right or wrong, but if they felt it was a total lost cause they could have turned back Helimed, so perhaps called too early. Yes the stats show a lot of things but it is situational.

Scotty

[BushyFromOz]

Seriously, given the OP' and the rest of the info (not having a go at ya over the AED bloke, just didn't know if i was reading it correctly) i'd say there is maybe a bit left wanting in the management of this patient, no matter how slim the odds.

All in or all out, no half arsed management

[Richard B the EMT]

Not a car accident, but had a shooting victim, head shot as well as torso. My partner got to the patient first, while I was grabbing equipment. Airway filling with blood, but still brweathing, if agonally. Paramedics joined us less than a minute later, and we transported to nearest hospital 3 minutes away, instead of Trauma Center 25 minutes away as the patient was in "Extremis".

Patient was "pronounced" as DOA less than a minute after arrival at the ER, and the senior Paramedic asked why we (my partner and I, both BLS EMTs) had initiated CPR. My partner said that, while agonal, there was still some air exchange, hense, he started the CPR.

After the fact, the Lieutenant, also a Paramedic, stated my partner and I had done nothing wrong, and had actually stayed within department and state DoH protocols.

[Kiwiology]

Yeah but Ben, this guy had weak pulses on scene, a pulse is a pulse none the less.

Correct you are but this bloke had also been down 20 minutes and was in PEA when the ambos got there, who knows if the cops actually felt a pulse or not?

I'm not into giving people the sheet-not-treat Rx unless absolutely necessary