Shot in the head. Did we do the right thing?

[Dustdevil]

Good commentary above. I agree with Asys, in that while I probably would not have gone for cardioversion in this scenario (at least, not at that time), a good case certainly can be made for it. I would not have done so for a couple of reasons, both of which have been touched upon already. Airway and oxygenation was the primary concern here, so I would have focused upon that. And ACLS in a trauma victim is something for the road, if at all. I would not delay transport for it. With a perfusing rhythm (pulse), cardioversion would have been low on my list of priorities. If anything, I would have spent that time on a trach. But again, that's just me, not PHTLS or the NREMT talking. There are a million trauma surgeons who probably would have done the same thing y'all did, so again, it certainly wasn't wrong. As AK reminds us daily with his signature line, there is more than one way to skin a cat. And if it creates some introspective evaluation of your performance and options for the future, then I'd say this run turned out very well for you. And no matter what you did or didn't do, there was only one way it was going to turn out for the victim.

[Rezq304]

Some of this kid's organs may have fewer issues than his brain and lungs do. Keeping him alive to justify harvest might be the best thing this particular patient does for society.

May be the "cold" answer, but I gotta say I agree with AZCEP on this one.

[1EMT-P]

I don't think that I would have cardioverted in this case, instead I think that I would have focused on airway management & rapid transport.

[dzmohr]

Monday morning is a GREAT day to be quarterback on Sunday's games!

Was the cardioversion correct? Maybe ... maybe not

Was it INCORRECT ....no, not at ALL You did a great job showing that you attempted to control the airway, I especially like that you made a judgement call and determined BVM in THIS case was better then repeated failed attempts at ET that was unlikely to succeed. Have an extra medic? Have reason to believe your next attempt might work? Go for it...in this case you made a decision and I have to think that with the thinking process you demonstrate in your narrative you made a value judgement I would BET was correct for the situation.

What I am confidant in is that you did your best in a horrible situation and if this guy WAS an organ donor you may have kept him viable ( CPR and cardioversion plus the injury may have made the heart less viable, much more would have been lost had he remained in decompensating VT. I doubt you could have done more to correct the hypoxia then what you were doing.

What I am CERTAIN of is that if I ever needed a medic for me or my family I would want you two!!!

You ran the call to the BEST of your ability and STILL question yourselves for how you could have done better!!!

I did that on every call I ran, great learning experience .. even if I came up with something I could have, maybe even SHOULD have, done differently I still could sleep well knowing I did my BEST!

[als2170]

I hate to analyze or answer about other medic's calls because i wasn't there and don't know everything that was happening. Sounds like you guys kept level heads and did the best you could. The object of this game is to deliver the patient to the ED in not worse condition than when you met them, which you did, so kudos to you.

As to the cardioversion, generally, the thinking is the heart is hypoxic, probably due to blood lose and a poor airway. That's why we generally 'consider' just one shock on a traumatic arrest (in my area anyway) instead focusing on quick transport and fluid replacement if possible. Just my two cents, but like I said it's important to remember, there's always a lot of distractions going on at a scene, that don't distract the 'Monday morning quarterbacks', so nobody can say anything but the people that were there.

[emt322632]

Sounds to me like you did all you could, and did it well within the extent of your protocol. Would I have done the same thing? I honestly don't know...

Definitely would have tried the airway first, but from what it sounds like, that wasn't happening. I think you guys did the best you could with what you had, which wasn't much...

Good job.