Your patient arrests as you pull up to the ER

[JakeEMTP]

If, as the OP suggests, we are at the hospital already, I'd be inclined to initiate CPR and ventilate the pt. while we wheeled them in. Taking the time to apply defibrillator pads would be detrimental to the pt. because, as we all know, time is tissue. The sooner we can get them to definitive care, the better the chance of a positive outcome. Why mess about in the ambulance?

[JPINFV]

Ahh, but what IS definitive care in a VF/VT arrest? More importantly, for those two rhythms, can you provide definitive care? I know I can.

As a basic who's admittedly never been in this situation, I'm going to have to go with the BLS care and defibrillator if indicated before moving across the ambulance bay and across the hall into the code room crowd.

[CTXMEDIC]

I've been there before and it always sucks! I make sure we have the basics covered and then move the patient into the ED. I make sure we have at least a good BLS airway with an adjunct and BVM and we are effectively ventilating the patient, make sure we are able to perform chest compressions, have the monitor attached to the patient with pads so we can manage any rhythm disturbances as needed and move the patient into the ED.

The last one we did, the initial call-in via radio painted the picture of a rapidly declining patient but still alive. The patient coded as we pulled into the ED and we rolled inside doing CPR and ventilating the patient. We stopped in front of the triage desk to get our room assignment and a quick reassessment revealed VFIB. After yelling "CLEAR" multiple times and defibrillating the patient in front of the triage desk, we had everyones attention and our room assignment. 8)

I just feel that if your at the ED and can move the patient inside providing you have the needed assistance to do so, it's your better course of action. You have more room to work, more hands to help you work and a few more things that we don't have the pleasure of using in the back of the ambulance. I don't see much benefit to the patient sitting outside the doors of the ED and working an arrest.

+10

[akroeze]

The sooner we can get them to definitive care, the better the chance of a positive outcome. Why mess about in the ambulance?

In many arrests we are definitive care otherwise we wouldn't be working and pronouncing in the field.

[crotchitymedic1986]

I dont understand the logic in this question. I am not aware of any circumstance where I would intentionally delay care to a patient, unless the scene was unsafe.

[JakeEMTP]

In many arrests we are definitive care otherwise we wouldn't be working and pronouncing in the field.

I understand that, really I do. But not in your scenario. We were at the hospital remember?

[crotchitymedic1986]

In many arrests we are definitive care otherwise we wouldn't be working and pronouncing in the field.

We are the definitive care in all arrests. Did you ever take an ACLS class with doctors ? The reason no one can fail ACLS now, is because the Physicians failed to often and whined about it.

[JakeEMTP]

We are the definitive care in all arrests. Did you ever take an ACLS class with doctors ? The reason no one can fail ACLS now, is because the Physicians failed to often and whined about it.

LOL!

[kristo]

Assuming the hospital you are pulling up to has the right resources, I'd say shock if indicated, then do a rolling CPR towards those resources.

I do not agree that resuscitation, be it ALS or BLS, is definitive care for a patient who had a problem that caused a cardiac arrest. Obviously, the arrest needs to be managed, this is usually done with certain protocols, i.e. ACLS, which are the same for doctors, nurses, paramedics, etc. Those protocols, however, are not definitive care for that patient.

If you don't agree with me, let me ask you one thing. In the event of a successful out of hospital resuscitation, i.e. you get a sinus rhythm, do you then take the patient to the hospital, or do you assume that he has received definitive care and does not need transport? Would you advise such a patient to sign an RMA (or your local variant) and leave?

[crotchitymedic1986]

Of course not. But no one works an arrest better than EMS (most of the time).

Most nurses cant read EKG, and you will be real lucky if the dermatologists who is working parttime in the ER, will remember any of the acls he took 4 years ago.